Provider Demographics
NPI:1962555201
Name:BAUM, JEAN MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:MARIE
Last Name:BAUM
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1520 SOUTH 70TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1566
Mailing Address - Country:US
Mailing Address - Phone:402-464-9000
Mailing Address - Fax:402-464-4447
Practice Address - Street 1:1520 SOUTH 70TH ST
Practice Address - Street 2:STE 200
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1566
Practice Address - Country:US
Practice Address - Phone:402-464-9000
Practice Address - Fax:402-464-4447
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2015-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NES60594Medicare UPIN