Provider Demographics
NPI:1679274575
Name:BAUGHMAN, MIRANDAH (FNP)
Entity type:Individual
Prefix:
First Name:MIRANDAH
Middle Name:
Last Name:BAUGHMAN
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 1:4960 LIMA RD
Mailing Address - Street 2:
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-9739
Mailing Address - Country:US
Mailing Address - Phone:585-519-9359
Mailing Address - Fax:
Practice Address - Street 1:144 COURT ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1036
Practice Address - Country:US
Practice Address - Phone:585-602-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726933-01163WP2201X
NY352360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care