Provider Demographics
NPI:1588912117
Name:BALDWIN, CARRIE ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELIZABETH
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 W VOTAW ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-1302
Mailing Address - Country:US
Mailing Address - Phone:260-726-8822
Mailing Address - Fax:260-726-7857
Practice Address - Street 1:428 W VOTAW ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1302
Practice Address - Country:US
Practice Address - Phone:260-726-8822
Practice Address - Fax:260-726-7857
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004073A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDINGMedicare PIN