Provider Demographics
NPI:1154666527
Name:BACCAM, NICOLE MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:BACCAM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 3RD AVE SE
Mailing Address - Street 2:LINN COMMUNITY CARE
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4009
Mailing Address - Country:US
Mailing Address - Phone:319-730-7321
Mailing Address - Fax:319-730-7366
Practice Address - Street 1:1201 3RD AVE SE
Practice Address - Street 2:LINN COMMUNITY CARE
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-4009
Practice Address - Country:US
Practice Address - Phone:319-730-7321
Practice Address - Fax:319-730-7366
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF110857363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health