Provider Demographics
NPI:1154544500
Name:BAUDO, FERN (RN, NP BC APRN)
Entity type:Individual
Prefix:MRS
First Name:FERN
Middle Name:
Last Name:BAUDO
Suffix:
Gender:F
Credentials:RN, NP BC APRN
Other - Prefix:MS
Other - First Name:FERN
Other - Middle Name:
Other - Last Name:WASSERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:283 E 4TH ST
Mailing Address - Street 2:APT #5A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7533
Mailing Address - Country:US
Mailing Address - Phone:646-235-4633
Mailing Address - Fax:646-964-4994
Practice Address - Street 1:108 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1621
Practice Address - Country:US
Practice Address - Phone:646-235-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY476531163WH1000X
NYF303237363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF303237OtherNP LICENSE NUMBER