Provider Demographics
NPI:1114759255
Name:BAALMAN, ABBY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:MARIE
Last Name:BAALMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2000
Mailing Address - Country:US
Mailing Address - Phone:618-498-7518
Mailing Address - Fax:618-498-3052
Practice Address - Street 1:390 MAPLE SUMMIT RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2000
Practice Address - Country:US
Practice Address - Phone:618-498-2101
Practice Address - Fax:618-498-8153
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IL085010750363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085010750OtherIL STATE LICENSE - PA
IL16340134OtherCAQH ID
IL1134163827OtherGROUP NPI - JCH MEDICAL GROUP
IL1811392970OtherRURAL HEALTH CLINIC NPI
IL1219129OtherNCCPA ID