Healthcare Provider Details

I. General information

NPI: 1740526821
Provider Name (Legal Business Name): ONIKA CHEMISE BAXTER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

7446 EASTWIND CV
MEMPHIS TN
38125-3541
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-8787
  • Fax:
Mailing address:
  • Phone: 901-289-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number189988
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: