Provider Demographics
NPI:1114256138
Name:BALDAUF, FAWN LYNN (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:FAWN
Middle Name:LYNN
Last Name:BALDAUF
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:LYNN
Other - Last Name:TETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:795 BALDAUF RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-6260
Mailing Address - Country:US
Mailing Address - Phone:570-778-4239
Mailing Address - Fax:
Practice Address - Street 1:311 E PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5512
Practice Address - Country:US
Practice Address - Phone:814-458-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028282363LP0808X
PARN581431163W00000X
PASP016692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily