Basic Information
| Provider Information | |||||||||
| NPI: | 1730287442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUM | ||||||||
| FirstName: | BEVERLY | ||||||||
| MiddleName: | AGAN | ||||||||
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| Credential: | GNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1331 N ELM ST | ||||||||
| Address2: | #200 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274016302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362737900 | ||||||||
| FaxNumber: | 3362738147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1331 N ELM ST | ||||||||
| Address2: | #200 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274016302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362737900 | ||||||||
| FaxNumber: | 3362738147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | 600016 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.