Provider Demographics
NPI:1447377056
Name:BAXTER, JEANNE ELLEN (RD)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:ELLEN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W160N10674 FIELDSTONE PASS
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-5705
Mailing Address - Country:US
Mailing Address - Phone:262-255-1836
Mailing Address - Fax:
Practice Address - Street 1:W160 N10674 FIELDSTONE PASS
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:262-255-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered