Healthcare Provider Details

I. General information

NPI: 1235539826
Provider Name (Legal Business Name): ELIZABETH BALDWIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LONE OAK LN
HARTFORD WI
53027-2600
US

IV. Provider business mailing address

110 LONE OAK LN
HARTFORD WI
53027-2600
US

V. Phone/Fax

Practice location:
  • Phone: 262-334-3451
  • Fax: 513-852-8525
Mailing address:
  • Phone: 262-670-1800
  • Fax: 262-836-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP7719-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: