Provider Demographics
NPI:1467550624
Name:BALDWIN, BEVERLY A (RN)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 LAMY LANE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3152
Mailing Address - Country:US
Mailing Address - Phone:318-322-6503
Mailing Address - Fax:
Practice Address - Street 1:4781 S. GRAND STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202
Practice Address - Country:US
Practice Address - Phone:318-362-5430
Practice Address - Fax:318-362-5424
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN052860163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)