Provider Demographics
NPI:1003040023
Name:BAISDEN, CHRISTAN MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CHRISTAN
Middle Name:MARIE
Last Name:BAISDEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CHRISTAN
Other - Middle Name:MARIE
Other - Last Name:GAZDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16819 BRADGATE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-4251
Mailing Address - Country:US
Mailing Address - Phone:216-228-9502
Mailing Address - Fax:
Practice Address - Street 1:16819 BRADGATE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4251
Practice Address - Country:US
Practice Address - Phone:216-228-9502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132186164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse