Provider Demographics
NPI:1114278413
Name:FERN BAUDO ADULT HEALTH NURSE PRACTITIONER PC
Entity Type:Organization
Organization Name:FERN BAUDO ADULT HEALTH NURSE PRACTITIONER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FERN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:646-235-4633
Mailing Address - Street 1:108 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1621
Mailing Address - Country:US
Mailing Address - Phone:646-235-4633
Mailing Address - Fax:
Practice Address - Street 1:108 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-1621
Practice Address - Country:US
Practice Address - Phone:646-235-4633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3303237363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty