Healthcare Provider Details

I. General information

NPI: 1649000241
Provider Name (Legal Business Name): JENNIFER LYNN BALDWIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

3916 KNOXVILLE AVE
LONG BEACH CA
90808-2245
US

V. Phone/Fax

Practice location:
  • Phone: 562-361-4606
  • Fax:
Mailing address:
  • Phone: 562-884-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number512708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: