Healthcare Provider Details

I. General information

NPI: 1780402354
Provider Name (Legal Business Name): AMY A BALDWIN ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 SPYGLASS HILL DR
BRUNSWICK OH
44212-3289
US

IV. Provider business mailing address

1469 SPYGLASS HILL DR
BRUNSWICK OH
44212-3289
US

V. Phone/Fax

Practice location:
  • Phone: 216-253-7107
  • Fax:
Mailing address:
  • Phone: 216-253-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberAPRN.CNP.0037710
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberAPRN.CNP.0037710
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.0037710
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: