Healthcare Provider Details

I. General information

NPI: 1710383468
Provider Name (Legal Business Name): JONATHAN E. BALDWIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 KINGS DAUGHTERS DR
FRANKFORT KY
40601-6514
US

IV. Provider business mailing address

425 LEWIS HARGETT CIR
LEXINGTON KY
40503-3590
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-5240
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11116026
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: