Provider Demographics
NPI:1912236183
Name:BAALMAN, JACQUELINE SUE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:BAALMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:LORSBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2000
Mailing Address - Country:US
Mailing Address - Phone:618-498-7518
Mailing Address - Fax:618-498-3052
Practice Address - Street 1:2 MYRTLE LANE
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:IL
Practice Address - Zip Code:62047
Practice Address - Country:US
Practice Address - Phone:618-576-9407
Practice Address - Fax:618-576-2260
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007954363LA2200X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205298003Medicare PIN
IL213122001Medicare PIN
IL204546001Medicare PIN
ILF400212796Medicare PIN
IL$$$$$$$$$001Medicaid