Provider Demographics
NPI:1265042915
Name:BAISDEN, DAWN MARIE
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:BAISDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 AVENUE C STE 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1100
Mailing Address - Country:US
Mailing Address - Phone:304-369-6400
Mailing Address - Fax:
Practice Address - Street 1:1 AVENUE C STE 102
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1100
Practice Address - Country:US
Practice Address - Phone:304-369-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant