Provider Demographics
NPI:1184335721
Name:BAUMA, NICHOLAS DARRELL (PA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DARRELL
Last Name:BAUMA
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1209 S FLOWER CIR APT A
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5281
Mailing Address - Country:US
Mailing Address - Phone:815-260-4064
Mailing Address - Fax:
Practice Address - Street 1:1209 S FLOWER CIR APT A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5281
Practice Address - Country:US
Practice Address - Phone:815-260-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant