Provider Demographics
NPI:1447652250
Name:BAXTER, JENNIFER (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 COUNTY ROAD 18
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-9358
Mailing Address - Country:US
Mailing Address - Phone:585-593-4678
Mailing Address - Fax:
Practice Address - Street 1:82 OLIVE ST
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:NY
Practice Address - Zip Code:14715-1310
Practice Address - Country:US
Practice Address - Phone:585-928-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse