Provider Demographics
NPI:1285037333
Name:BAXLEY, NJAMEH (CRNP)
Entity Type:Individual
Prefix:
First Name:NJAMEH
Middle Name:
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:409 SOUTH FRONT STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 TECHNOLOGY PKWY
Practice Address - Street 2:SUITE 440
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9413
Practice Address - Country:US
Practice Address - Phone:717-791-2540
Practice Address - Fax:717-791-2549
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2021-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASP014290363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102973017Medicaid
PA102973017Medicaid