Provider Demographics
NPI:1164966438
Name:BAUMEISTER, MICHELLE (APN)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:BAUMEISTER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1221
Mailing Address - Country:US
Mailing Address - Phone:973-906-1815
Mailing Address - Fax:
Practice Address - Street 1:24 HALLVARD TER
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-4235
Practice Address - Country:US
Practice Address - Phone:973-906-1815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00668400363L00000X
NY309102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner