Provider Demographics
NPI:1427642594
Name:BAULDREE, NOLAN PENN (CRNP)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:PENN
Last Name:BAULDREE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4112
Mailing Address - Country:US
Mailing Address - Phone:205-871-7007
Mailing Address - Fax:
Practice Address - Street 1:2556 HELENA RD STE C
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AL
Practice Address - Zip Code:35080-3260
Practice Address - Country:US
Practice Address - Phone:205-685-4870
Practice Address - Fax:205-685-4869
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily