Healthcare Provider Details

I. General information

NPI: 1164410031
Provider Name (Legal Business Name): SHARI RAE BALDINGER-DOUGLAS MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: SHARI RAE BALDINGER MS CGC

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST ABBOTT-NORTHWESTERN HOSPITAL-39503
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

3915 W 42ND ST
EDINA MN
55416-5001
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3536
  • Fax: 612-863-5697
Mailing address:
  • Phone: 952-922-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: