Healthcare Provider Details

I. General information

NPI: 1992995088
Provider Name (Legal Business Name): ANDREA L BALDWIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA L SMITH

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST ANESTHESIA
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

1235 E CHEROKEE ST ANESTHESIA
SPRINGFIELD MO
65804-2203
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-6863
  • Fax: 417-820-6868
Mailing address:
  • Phone: 417-820-6863
  • Fax: 417-820-6868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2003012794
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2003012794
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: