Healthcare Provider Details

I. General information

NPI: 1023423233
Provider Name (Legal Business Name): WILLIAM JOHN BAUM FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 NH 27
RAYMOND NH
03077-1220
US

IV. Provider business mailing address

128 NH 27
RAYMOND NH
03077-1220
US

V. Phone/Fax

Practice location:
  • Phone: 978-467-5622
  • Fax: 603-659-8003
Mailing address:
  • Phone: 603-659-3106
  • Fax: 603-659-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number063367-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: