Healthcare Provider Details

I. General information

NPI: 1962894568
Provider Name (Legal Business Name): GAIL BALDWIN RN CCRN WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 TOMAHAWK CT
MARSHFIELD MO
65706-1003
US

IV. Provider business mailing address

761 TOMAHAWK CT
MARSHFIELD MO
65706-1003
US

V. Phone/Fax

Practice location:
  • Phone: 417-839-7637
  • Fax:
Mailing address:
  • Phone: 417-839-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number120087
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: