Provider Demographics
NPI:1336366673
Name:BALDWIN, JEAN MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2439
Mailing Address - Country:US
Mailing Address - Phone:360-385-9400
Mailing Address - Fax:360-385-9401
Practice Address - Street 1:615 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2439
Practice Address - Country:US
Practice Address - Phone:360-385-9400
Practice Address - Fax:360-385-9401
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00104450363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7311707Medicaid
WABJ5055721OtherDEA
WA7311707Medicaid