Provider Demographics
NPI:1619182656
Name:BALDWIN, LISA ANN (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4910 AIRPORT PLAZA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1377
Mailing Address - Country:US
Mailing Address - Phone:624-213-7275
Mailing Address - Fax:562-420-8948
Practice Address - Street 1:4910 AIRPORT PLAZA DR STE 210
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1377
Practice Address - Country:US
Practice Address - Phone:562-421-3727
Practice Address - Fax:562-420-8948
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHI654ZMedicare PIN