Provider Demographics
NPI:1174851406
Name:BAUST, JENNIFER (RN, LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BAUST
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 W SHADY DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2872
Mailing Address - Country:US
Mailing Address - Phone:302-723-0185
Mailing Address - Fax:
Practice Address - Street 1:1824 N SCOTT ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2318
Practice Address - Country:US
Practice Address - Phone:302-723-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECQ-0000002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist