Healthcare Provider Details

I. General information

NPI: 1508028606
Provider Name (Legal Business Name): ANGELA GENETTE BAUMEISTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 08/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 13TH ST NW
ALBUQUERQUE NM
87102-1841
US

IV. Provider business mailing address

707 13TH ST NW
ALBUQUERQUE NM
87102-1841
US

V. Phone/Fax

Practice location:
  • Phone: 781-913-0567
  • Fax:
Mailing address:
  • Phone: 781-913-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-2008-0029
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: