Provider Demographics
NPI:1609279645
Name:BALDWIN, RACHEL CARBONI (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:CARBONI
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:CHRISTINE
Other - Last Name:CARBONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:603 YOUNG AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-4334
Mailing Address - Country:US
Mailing Address - Phone:423-718-6806
Mailing Address - Fax:
Practice Address - Street 1:410 N CEDAR BLUFF RD
Practice Address - Street 2:STE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3623
Practice Address - Country:US
Practice Address - Phone:865-342-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-05
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19714367500000X
DCRN1022269163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ014898Medicaid
TNQ014898Medicaid