Provider Demographics
NPI:1881930824
Name:BAUDNER, JESSIE R (ANP BC)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:R
Last Name:BAUDNER
Suffix:
Gender:F
Credentials:ANP BC
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:R
Other - Last Name:BORDELEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 WATERFORD PKWY S STE 306
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1234
Mailing Address - Country:US
Mailing Address - Phone:860-447-2489
Mailing Address - Fax:860-437-1231
Practice Address - Street 1:196 WATERFORD PKWY S STE 306
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1234
Practice Address - Country:US
Practice Address - Phone:860-447-2489
Practice Address - Fax:860-437-1231
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5228363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health