Provider Demographics
NPI:1790446557
Name:BALDEH, ISATOU (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:ISATOU
Middle Name:
Last Name:BALDEH
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12738 LEYTE ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6792
Mailing Address - Country:US
Mailing Address - Phone:612-735-0967
Mailing Address - Fax:
Practice Address - Street 1:12738 LEYTE ST NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6792
Practice Address - Country:US
Practice Address - Phone:612-735-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN189093-4163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty