Provider Demographics
NPI:1255440186
Name:BALDWIN, SARA MARIE (PNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:SCHLACHTENHAUFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10113 SAN REMO PL STE 300
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-1622
Mailing Address - Country:US
Mailing Address - Phone:919-244-0311
Mailing Address - Fax:
Practice Address - Street 1:1655 WAKE DR UNIT 101
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4746
Practice Address - Country:US
Practice Address - Phone:919-556-4779
Practice Address - Fax:919-556-5277
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC300263363LP0200X
NC172839363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000243Medicaid
P41983Medicare UPIN