Provider Demographics
NPI:1114256138
Name:BALDAUF, FAWN LYNN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:FAWN
Middle Name:LYNN
Last Name:BALDAUF
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:FAWN
Other - Middle Name:LYNN
Other - Last Name:TETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:795 BALDAUF RD
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-6260
Mailing Address - Country:US
Mailing Address - Phone:570-778-4239
Mailing Address - Fax:
Practice Address - Street 1:502 PARK AVE
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-2100
Practice Address - Country:US
Practice Address - Phone:814-765-2950
Practice Address - Fax:814-765-0173
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN581431163W00000X
PASP016692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse