Provider Demographics
NPI:1679601249
Name:BAUGHMAN, MARY ANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANNE
Last Name:BAUGHMAN
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 1:1214 W CEDAR LOOP
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1573
Mailing Address - Country:US
Mailing Address - Phone:712-225-2594
Mailing Address - Fax:712-225-6956
Practice Address - Street 1:1200 W CEDAR LOOP
Practice Address - Street 2:CHEROKEE MENTAL HEALTH INSTITUTE
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1573
Practice Address - Country:US
Practice Address - Phone:712-225-2594
Practice Address - Fax:712-225-6956
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant