Healthcare Provider Details

I. General information

NPI: 1184431967
Provider Name (Legal Business Name): JESSICA ROCHELLE BALDWIN BSN, RN, CEN, SANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2024
Last Update Date: 12/14/2024
Certification Date: 12/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

109 WOODVILLE RD
MITCHELL IN
47446-6900
US

V. Phone/Fax

Practice location:
  • Phone: 812-918-3059
  • Fax:
Mailing address:
  • Phone: 252-474-7051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28284951A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: