Healthcare Provider Details

I. General information

NPI: 1811947526
Provider Name (Legal Business Name): SHARON M BALDWIN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 16TH AVE N
NAMPA ID
83687-4058
US

IV. Provider business mailing address

13211 N ANDYS GULCH RD
BOISE ID
83714-9427
US

V. Phone/Fax

Practice location:
  • Phone: 208-467-7654
  • Fax: 208-318-1391
Mailing address:
  • Phone: 208-841-6541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberCNS25A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2006504405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2006508900
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: