Provider Demographics
NPI:1558652594
Name:BALDWIN, JESSIE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:MARIE
Last Name:BALDWIN
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 1:47 ROWLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-1424
Mailing Address - Country:US
Mailing Address - Phone:419-560-6873
Mailing Address - Fax:
Practice Address - Street 1:47 ROWLAND AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-1424
Practice Address - Country:US
Practice Address - Phone:419-560-6873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126798-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse