Healthcare Provider Details

I. General information

NPI: 1245303957
Provider Name (Legal Business Name): VERNON T BALDWIN JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOMMY BALDWIN C.R.N.A.

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4864 JACKSON ST
MONROE LA
71202-6400
US

IV. Provider business mailing address

4864 JACKSON ST
MONROE LA
71202-6400
US

V. Phone/Fax

Practice location:
  • Phone: 318-330-7000
  • Fax: 318-675-5666
Mailing address:
  • Phone: 318-330-7000
  • Fax: 318-675-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP01330
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: