Provider Demographics
NPI:1831458512
Name:NICHOLE BAUGHMAN, SURGICAL ASSISTANT LLC
Entity Type:Organization
Organization Name:NICHOLE BAUGHMAN, SURGICAL ASSISTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN FIRST ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:609-425-5274
Mailing Address - Street 1:203 MISTLETOE AVE
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1320
Mailing Address - Country:US
Mailing Address - Phone:609-425-5274
Mailing Address - Fax:
Practice Address - Street 1:203 MISTLETOE AVE
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1320
Practice Address - Country:US
Practice Address - Phone:609-425-5274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR11682500282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital