Provider Demographics
NPI:1487038055
Name:BALDOMER, NATHALIE (LPN)
Entity Type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:BALDOMER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3527
Mailing Address - Country:US
Mailing Address - Phone:516-775-0480
Mailing Address - Fax:
Practice Address - Street 1:50 CLINTON ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4281
Practice Address - Country:US
Practice Address - Phone:516-933-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309484-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse