Provider Demographics
NPI:1508028606
Name:BAUMEISTER, ANGELA GENETTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:GENETTE
Last Name:BAUMEISTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 13TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1841
Mailing Address - Country:US
Mailing Address - Phone:781-913-0567
Mailing Address - Fax:
Practice Address - Street 1:707 13TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1841
Practice Address - Country:US
Practice Address - Phone:781-913-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA-2008-0029363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59509082Medicaid
NMNM400306OtherMEDICARE PTAN