Provider Demographics
NPI:1306231543
Name:BAISDEN, WILLIAM (RN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BAISDEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12068 W TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-6638
Mailing Address - Country:US
Mailing Address - Phone:208-860-5941
Mailing Address - Fax:
Practice Address - Street 1:12068 W TIDEWATER DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-6638
Practice Address - Country:US
Practice Address - Phone:208-860-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-41898163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical