Provider Demographics
NPI:1184849010
Name:BAUGHCUM, DONNA ROBERTSON (RN,MSN,CS)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:ROBERTSON
Last Name:BAUGHCUM
Suffix:
Gender:F
Credentials:RN,MSN,CS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WEST NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2149
Mailing Address - Country:US
Mailing Address - Phone:617-964-1984
Mailing Address - Fax:
Practice Address - Street 1:1121 WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465-2149
Practice Address - Country:US
Practice Address - Phone:617-964-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA135529363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health