Provider Demographics
NPI:1972129567
Name:BAFFOE, IRENE
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:BAFFOE
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 1:18 SNOWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-6516
Mailing Address - Country:US
Mailing Address - Phone:774-345-4186
Mailing Address - Fax:
Practice Address - Street 1:18 SNOWBERRY LN
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-6516
Practice Address - Country:US
Practice Address - Phone:774-345-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2275011363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily