Provider Demographics
NPI:1811375892
Name:BALDWIN, ALLISON CAROLYN (ATC, PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:CAROLYN
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:ATC, PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:CAROLYN
Other - Last Name:PREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, PA-C
Mailing Address - Street 1:4831 EAGLES WATCH LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-9531
Mailing Address - Country:US
Mailing Address - Phone:608-417-0376
Mailing Address - Fax:
Practice Address - Street 1:8240 NAAB RD STE 416
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-0012
Practice Address - Country:US
Practice Address - Phone:317-306-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
IN10003813A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer