MEDICARE: MRS. LARA MITCHELL BAUDUCCO APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15250200	NJ

General Provider Information

NPI Number	:	1750194502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LARA MITCHELL BAUDUCCO APN

Provider Business Mailing Address
First Line	:	1328 SHELLY LN
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08034-3119
Country	:	US
Telephone Number	:	267-242-2149
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ASHURST LN STE 115
Second Line	:
City	:	MOUNT HOLLY
State	:	NJ
Zip	:	08060-1202
Country	:	US
Telephone Number	:	609-853-5494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	01/27/2025

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