Provider Demographics
NPI:1033577028
Name:BALDWIN, HAILEY ROSS
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:ROSS
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-9222
Mailing Address - Country:US
Mailing Address - Phone:406-446-2345
Mailing Address - Fax:
Practice Address - Street 1:2525 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9222
Practice Address - Country:US
Practice Address - Phone:406-446-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant