Provider Demographics
NPI:1811947526
Name:BALDWIN, SHARON M (CNS)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:M
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13211 N ANDYS GULCH RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-9427
Mailing Address - Country:US
Mailing Address - Phone:208-841-6541
Mailing Address - Fax:
Practice Address - Street 1:207 16TH AVE N
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-4058
Practice Address - Country:US
Practice Address - Phone:208-467-7654
Practice Address - Fax:208-318-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS25A163WP0809X
UT2006504405163WP0809X
UT2006508900163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806765200Medicaid
ID806765200Medicaid