Provider Demographics
NPI:1710275128
Name:BAERTSCH, MEGAN JENNIE (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JENNIE
Last Name:BAERTSCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2824 JEAN DULUTH RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2660
Mailing Address - Country:US
Mailing Address - Phone:218-780-7773
Mailing Address - Fax:
Practice Address - Street 1:1420 LONDON RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2437
Practice Address - Country:US
Practice Address - Phone:218-728-8548
Practice Address - Fax:763-450-3986
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 179432-8363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNR 179432-8OtherMN STATE LICENSURE