Healthcare Provider Details

I. General information

NPI: 1427643485
Provider Name (Legal Business Name): AMANDA MARIE BALDWIN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JEFFERSON REGIONAL MEDICAL CENTER 575 COAL VALLEY RD
CLAIRTON PA
15025-3729
US

IV. Provider business mailing address

575 COAL VALLEY RD STE 504
CLAIRTON PA
15025-3729
US

V. Phone/Fax

Practice location:
  • Phone: 412-469-7900
  • Fax: 412-469-7919
Mailing address:
  • Phone: 412-469-7900
  • Fax: 412-469-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP023277
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1038902690001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: