1528374220 NPI number — MRS. NANCY ELIZABETH BAXTER M.D.

Table of content: MRS. NANCY ELIZABETH BAXTER M.D. (NPI 1528374220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528374220 NPI number — MRS. NANCY ELIZABETH BAXTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAXTER
Provider First Name:
NANCY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAXTER
Provider Other First Name:
NANCY
Provider Other Middle Name:
BALLENAS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1528374220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 W 10TH AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-221-5910
Provider Business Mailing Address Fax Number:
509-221-5912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 W 10TH AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-221-5910
Provider Business Practice Location Address Fax Number:
509-221-5912
Provider Enumeration Date:
08/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD00034675 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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