=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952582231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH ANN BAXTER CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2007
-----------------------------------------------------
Last Update Date | 01/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1412 HAMPTON DR
-----------------------------------------------------
City | DOWNINGTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19335-3674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-209-6797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1412 HAMPTON DR
-----------------------------------------------------
City | DOWNINGTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19335-3674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-209-6797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | VP005245B
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------