Healthcare Provider Details

I. General information

NPI: 1558100230
Provider Name (Legal Business Name): CHANA BAUMANN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 REGENT DR
LIDO BEACH NY
11561-4934
US

IV. Provider business mailing address

225 REGENT DR
LIDO BEACH NY
11561-4934
US

V. Phone/Fax

Practice location:
  • Phone: 347-891-4160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number353433
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number627527
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: