Provider Demographics
NPI:1962646885
Name:BAULKMAN, TONYA CASSANDRA
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:CASSANDRA
Last Name:BAULKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 BIRR ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14613-1302
Mailing Address - Country:US
Mailing Address - Phone:585-235-4786
Mailing Address - Fax:
Practice Address - Street 1:348 BIRR ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14613-1302
Practice Address - Country:US
Practice Address - Phone:585-235-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283392-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse