Provider Demographics
NPI:1508468711
Name:BAXTER, SHARI LEE
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:LEE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7079 PROSPECT DUBLIN RD
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:OH
Mailing Address - Zip Code:43342-9553
Mailing Address - Country:US
Mailing Address - Phone:740-225-2087
Mailing Address - Fax:
Practice Address - Street 1:99 LYNN ST
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-1137
Practice Address - Country:US
Practice Address - Phone:740-225-2087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00002585973747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0000258597Medicaid