Healthcare Provider Details

I. General information

NPI: 1780537050
Provider Name (Legal Business Name): KATIE JEANNE BALDWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PARK PL STE 400
APPLETON WI
54914-8271
US

IV. Provider business mailing address

955 MILWAUKEE ST
LOMIRA WI
53048-9770
US

V. Phone/Fax

Practice location:
  • Phone: 920-574-3096
  • Fax:
Mailing address:
  • Phone: 920-791-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number18052-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: