Provider Demographics
NPI:1023063609
Name:BAXTER, JAMIE LEE (RD, LDN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:CAREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1701 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-2629
Mailing Address - Country:US
Mailing Address - Phone:309-721-9279
Mailing Address - Fax:
Practice Address - Street 1:100 E LE FEVRE RD
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:IL
Practice Address - Zip Code:61081-1278
Practice Address - Country:US
Practice Address - Phone:815-625-0400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered