=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184431967
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA ROCHELLE BALDWIN BSN, RN, CEN, SANE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2024
-----------------------------------------------------
Last Update Date | 12/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2651 E DISCOVERY PKWY
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47408-9059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-918-3059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 WOODVILLE RD
-----------------------------------------------------
City | MITCHELL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47446-6900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-474-7051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Registered Nurse
-----------------------------------------------------
License Number | 28284951A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------