Provider Demographics
NPI:1316411713
Name:BAUMEISTER, NICOLE ALYSE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYSE
Last Name:BAUMEISTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALYSE
Other - Last Name:ZBICIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:131 MADISON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7360
Mailing Address - Country:US
Mailing Address - Phone:973-540-9700
Mailing Address - Fax:973-540-9717
Practice Address - Street 1:131 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7360
Practice Address - Country:US
Practice Address - Phone:973-540-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00625200363AM0700X, 363AS0400X
NC0010-08739363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical