Provider Demographics
NPI:1578079141
Name:BALDWIN, DONNA KAYE (PCA)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:KAYE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:KAYE
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1168 FRANCES CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:HARTS
Mailing Address - State:WV
Mailing Address - Zip Code:25524
Mailing Address - Country:US
Mailing Address - Phone:304-356-4562
Mailing Address - Fax:304-558-4563
Practice Address - Street 1:1168 FRANCES CREEK ROAD
Practice Address - Street 2:
Practice Address - City:HARTS
Practice Address - State:WV
Practice Address - Zip Code:25524
Practice Address - Country:US
Practice Address - Phone:304-855-8703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2901019000OtherPROVIDER ID