Provider Demographics
NPI:1669407474
Name:BALDWIN, ELIZABETH GILL (ARNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GILL
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1500 N WARNER ST
Mailing Address - Street 2:#1035
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98416-1035
Mailing Address - Country:US
Mailing Address - Phone:253-879-2773
Mailing Address - Fax:
Practice Address - Street 1:1500 N WARNER ST
Practice Address - Street 2:#1035
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98416-1035
Practice Address - Country:US
Practice Address - Phone:253-879-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQ57239Medicare UPIN