Healthcare Provider Details

I. General information

NPI: 1871800409
Provider Name (Legal Business Name): VICKY T BAUGHER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N MAIN ST
UNION BRIDGE MD
21791-9102
US

IV. Provider business mailing address

PO BOX 591
UNION BRIDGE MD
21791-0592
US

V. Phone/Fax

Practice location:
  • Phone: 443-937-6258
  • Fax: 949-404-6023
Mailing address:
  • Phone: 443-937-6258
  • Fax: 949-404-6023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR139731
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: