Provider Demographics
NPI:1174929335
Name:BAUMGART, NORA RAHN (PA-C)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:RAHN
Last Name:BAUMGART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:RAHN
Other - Last Name:DECHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1341 W GRANVILLE AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1910
Mailing Address - Country:US
Mailing Address - Phone:860-817-1927
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-695-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005268363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant