Provider Demographics
NPI:1073690707
Name:BAYLOCK, ANNE G (ADV PRACTICE RN)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:G
Last Name:BAYLOCK
Suffix:
Gender:F
Credentials:ADV PRACTICE RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 TOWN HILL RD
Mailing Address - Street 2:PO BOX 573
Mailing Address - City:PITTSFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05763-0573
Mailing Address - Country:US
Mailing Address - Phone:802-483-9395
Mailing Address - Fax:
Practice Address - Street 1:1 COMMONS ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4652
Practice Address - Country:US
Practice Address - Phone:802-747-1857
Practice Address - Fax:802-747-0129
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010759364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00058662OtherBC/BS
VT1008733Medicaid
VN2855Medicare ID - Type Unspecified