Provider Demographics
NPI:1518943422
Name:BAXTER, SUZANNE R (PA-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:BAXTER
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 1:2230 WILEY BLVD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-2364
Mailing Address - Country:US
Mailing Address - Phone:319-396-1983
Mailing Address - Fax:319-396-3183
Practice Address - Street 1:2230 WILEY BLVD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-2364
Practice Address - Country:US
Practice Address - Phone:319-396-1983
Practice Address - Fax:319-396-3183
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001209363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S77492Medicare UPIN
IA48957Medicare ID - Type Unspecified