Provider Demographics
NPI:1760861090
Name:BAXTER, ERIN NICOLE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 S DECATUR BLVD APT 1112
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-5836
Mailing Address - Country:US
Mailing Address - Phone:805-814-9729
Mailing Address - Fax:
Practice Address - Street 1:3625 S DECATUR BLVD APT 1112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5836
Practice Address - Country:US
Practice Address - Phone:805-814-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner