=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497202121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA MARIE BALDWIN RN, NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2016
-----------------------------------------------------
Last Update Date | 07/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 818 PIER VIEW WAY
-----------------------------------------------------
City | OCEANSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92054-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-631-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2150 PINEWOOD DR
-----------------------------------------------------
City | SOUTH LAKE TAHOE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96150-5144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-318-8367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SF0001X
-----------------------------------------------------
Taxonomy Name | Family Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 95009501
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | NP95005907
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------