Healthcare Provider Details

I. General information

NPI: 1073452686
Provider Name (Legal Business Name): SHELBY ELIZABETH BAUMGARTNER BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 DUSTY LN
RALEIGH NC
27604-4230
US

IV. Provider business mailing address

3701 DUSTY LN
RALEIGH NC
27604-4230
US

V. Phone/Fax

Practice location:
  • Phone: 716-307-2818
  • Fax:
Mailing address:
  • Phone: 716-307-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number316548
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: