Provider Demographics
NPI:1043789183
Name:BAXTER, ALESIA JO (RN)
Entity Type:Individual
Prefix:
First Name:ALESIA
Middle Name:JO
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1935
Mailing Address - Country:US
Mailing Address - Phone:712-243-2606
Mailing Address - Fax:712-243-2688
Practice Address - Street 1:1500 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1935
Practice Address - Country:US
Practice Address - Phone:712-243-2606
Practice Address - Fax:712-243-2688
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse