Provider Demographics
NPI:1417282252
Name:BASKERVILLE, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BASKERVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MATERNAL
Other - Middle Name:
Other - Last Name:INSTINCT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CD
Mailing Address - Street 1:315 CHERRY HILL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-5329
Mailing Address - Country:US
Mailing Address - Phone:408-771-8854
Mailing Address - Fax:
Practice Address - Street 1:315 CHERRY HILL POINTE DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5329
Practice Address - Country:US
Practice Address - Phone:408-771-8854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula