Basic Information
| Provider Information | |||||||||
| NPI: | 1700881026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAXTER-ROGERS | ||||||||
| FirstName: | CYMANDE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038186044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034473347 | ||||||||
| FaxNumber: | 6034440145 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | WOLFEBORO | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038944455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035967500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP9218239 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | 074752-23 | NH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | 07475223 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 3107999 | 05 | NH | MEDICAID | 306591000 | 05 | FL | MEDICAID |