1861411209 NPI number — JANICE ANN BALDWIN CNM

Table of content: JANICE ANN BALDWIN CNM (NPI 1861411209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861411209 NPI number — JANICE ANN BALDWIN CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDWIN
Provider First Name:
JANICE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861411209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 E CEDAR ST
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
SOUTH BEND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46617-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-335-8707
Provider Business Mailing Address Fax Number:
574-335-0741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 LAKE AVE
Provider Second Line Business Practice Location Address:
SUITE 99
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46563-7830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-941-2977
Provider Business Practice Location Address Fax Number:
574-941-2978
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  28162747A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 28162747A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000569011 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200410010 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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