Provider Demographics
NPI:1194725028
Name:BADENHOP, CAROLYN (CNP)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BADENHOP
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 BRIGHAM DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7114
Mailing Address - Country:US
Mailing Address - Phone:419-872-7745
Mailing Address - Fax:419-874-7758
Practice Address - Street 1:1601 BRIGHAM DR
Practice Address - Street 2:SUITE 250
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7114
Practice Address - Country:US
Practice Address - Phone:419-872-7745
Practice Address - Fax:419-874-7758
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01446363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH500025100OtherRRMC
OH2239714Medicaid
OH000000378999OtherANTHEM
OHP30403Medicare UPIN
OH2239714Medicaid