Provider Demographics
NPI:1639823495
Name:BAXTER, LAURA BETH (CPM, LM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:BAXTER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-6062
Mailing Address - Country:US
Mailing Address - Phone:715-679-4878
Mailing Address - Fax:866-933-1286
Practice Address - Street 1:105 PINE CREST LN
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-8230
Practice Address - Country:US
Practice Address - Phone:715-445-2277
Practice Address - Fax:866-933-1286
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI246-49176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife