Provider Demographics
NPI:1962437251
Name:BAXTER, CATHERINE LUVERNE (FNP)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LUVERNE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 W 3665 S
Mailing Address - Street 2:
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044
Mailing Address - Country:US
Mailing Address - Phone:801-250-9638
Mailing Address - Fax:801-250-3204
Practice Address - Street 1:840 W 3665 S
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:801-250-3204
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1879584405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS70644Medicare UPIN
UT005700507Medicare ID - Type Unspecified