Provider Demographics
NPI:1134537814
Name:BALDWIN, CARLA LEVONNE (STNA)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:LEVONNE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 ASHTON CROSS
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9005
Mailing Address - Country:US
Mailing Address - Phone:614-524-6313
Mailing Address - Fax:
Practice Address - Street 1:3516 ASHTON CROSS
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9005
Practice Address - Country:US
Practice Address - Phone:614-524-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4005684912063747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846228Medicaid