Provider Demographics
NPI:1508464926
Name:BAXLEY, MAGGIE ABERNATHY (RDN)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:ABERNATHY
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALA MOANA BLVD STE 6D
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4984
Mailing Address - Country:US
Mailing Address - Phone:808-777-4000
Mailing Address - Fax:808-447-0571
Practice Address - Street 1:500 ALA MOANA BLVD STE 6D
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4984
Practice Address - Country:US
Practice Address - Phone:808-777-4000
Practice Address - Fax:808-447-0571
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL86054066OtherCOMMISSION ON DIETETIC REGISTRATION