Healthcare Provider Details

I. General information

NPI: 1689742074
Provider Name (Legal Business Name): KATHRYN R BALDOR APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WYMAN RD
WESTMINSTER MA
01473-1601
US

IV. Provider business mailing address

16 WYMAN RD
WESTMINSTER MA
01473-1601
US

V. Phone/Fax

Practice location:
  • Phone: 978-874-6427
  • Fax: 508-829-2905
Mailing address:
  • Phone: 978-874-6427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0138831
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: