Provider Demographics
NPI:1427162429
Name:DE BALDO, PAUL D JR (PMHNP)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:D
Last Name:DE BALDO
Suffix:JR
Gender:M
Credentials:PMHNP
Other - Prefix:
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Mailing Address - Street 1:12607 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6055
Mailing Address - Country:US
Mailing Address - Phone:360-896-4460
Mailing Address - Fax:360-896-4478
Practice Address - Street 1:12607 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:360-418-6001
Practice Address - Fax:360-896-4478
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAWA AP30006380363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health