Healthcare Provider Details

I. General information

NPI: 1780172718
Provider Name (Legal Business Name): JADRIENE BALDUF RN, IBCLC, CCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 WASHINGTON AVE
BATAVIA NY
14020-2113
US

IV. Provider business mailing address

164 WASHINGTON AVE
BATAVIA NY
14020-2113
US

V. Phone/Fax

Practice location:
  • Phone: 585-344-5331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number639469
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number639469
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number152420
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: