Provider Demographics
NPI:1730287442
Name:BAUM, BEVERLY AGAN (GNP-C)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:AGAN
Last Name:BAUM
Suffix:
Gender:F
Credentials:GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N ELM ST
Mailing Address - Street 2:#200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6302
Mailing Address - Country:US
Mailing Address - Phone:336-273-7900
Mailing Address - Fax:336-273-8147
Practice Address - Street 1:1331 N ELM ST
Practice Address - Street 2:#200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6302
Practice Address - Country:US
Practice Address - Phone:336-273-7900
Practice Address - Fax:336-273-8147
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600016363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS17588Medicare UPIN
NC2598888Medicare ID - Type Unspecified