Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN144580 | GA |
NPI | 1003404880 |
---|---|
Provider Name | Julie J Baute |
First Address | Marietta, GA 30060-7242 |
Second Address | Marietta, GA 30060-7242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2021 |
Last Update Date | 06/01/2021 |