Provider Demographics
NPI:1003198482
Name:BALDOSSER, JANELLE JEAN (MSN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:JEAN
Last Name:BALDOSSER
Suffix:
Gender:F
Credentials:MSN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MCKINLEY PARK DR.
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6397
Mailing Address - Country:US
Mailing Address - Phone:740-383-8400
Mailing Address - Fax:
Practice Address - Street 1:725 N SANDUSKY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-1463
Practice Address - Country:US
Practice Address - Phone:740-383-8665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12506-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5514803Medicaid
36-0011Medicare UPIN