Provider Demographics
NPI:1184952988
Name:BALDASARE, KEVIN (RN)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:BALDASARE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 632572
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2572
Mailing Address - Country:US
Mailing Address - Phone:513-672-4128
Mailing Address - Fax:513-672-4479
Practice Address - Street 1:1241 SHAWHAN RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:OH
Practice Address - Zip Code:45152-9695
Practice Address - Country:US
Practice Address - Phone:513-865-5204
Practice Address - Fax:513-672-3323
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH256928367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH256928OtherLICENSE