Provider Demographics
NPI:1962954768
Name:BALDWIN, JERRIE DENISE (CRNP)
Entity type:Individual
Prefix:
First Name:JERRIE
Middle Name:DENISE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 NORMANDIE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2728
Mailing Address - Country:US
Mailing Address - Phone:334-288-7531
Mailing Address - Fax:334-288-7539
Practice Address - Street 1:2173 NORMANDIE DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2728
Practice Address - Country:US
Practice Address - Phone:334-288-7531
Practice Address - Fax:334-288-7531
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-109344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily