Provider Demographics
NPI:1386241909
Name:BAXTER, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:BAXTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 W ENGLISH MEADOWS DR APT B102
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3976
Mailing Address - Country:US
Mailing Address - Phone:414-758-9822
Mailing Address - Fax:
Practice Address - Street 1:2060 S 61ST ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-1419
Practice Address - Country:US
Practice Address - Phone:414-758-9822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI385H00000X
WI336467376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care