Provider Demographics
NPI:1528374220
Name:BAXTER, NANCY ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:BALLENAS
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:320 W 10TH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6302
Mailing Address - Country:US
Mailing Address - Phone:509-221-5910
Mailing Address - Fax:509-221-5912
Practice Address - Street 1:320 W 10TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6302
Practice Address - Country:US
Practice Address - Phone:509-221-5910
Practice Address - Fax:509-221-5912
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034675208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics