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General NPI Number Information
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NPI Number | 1588845382
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Entity Type | Organization
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Legal Business Name | BETH ANNE BAXTER, RN/CS, LLC
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Dates
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Enumeration Date | 11/20/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 822 W 1ST ST STE 1
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2384
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Country | US
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Telephone | 812-323-0971
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Fax |
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Provider Business Mailing Address
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Address Line | 822 W 1ST ST STE 1
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2384
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Country | US
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Telephone | 812-323-0971
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BETH A BAXTER
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Credential | NP
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Telephone | 812-323-0971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 71000050A
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License Number State | IN
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