Provider Demographics
NPI:1801260898
Name:BAUMGARTNER, ERICA RACHELLE
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:RACHELLE
Last Name:BAUMGARTNER
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 1:152 WITTENBRAKER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-5035
Mailing Address - Country:US
Mailing Address - Phone:812-621-0453
Mailing Address - Fax:
Practice Address - Street 1:152 WITTENBRAKER AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-5035
Practice Address - Country:US
Practice Address - Phone:812-621-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28197170A163WE0003X
IN71006087A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency