Provider Demographics
NPI:1255926259
Name:BALDWIN, BEVERLY R (NP-C)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:R
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-4458
Mailing Address - Country:US
Mailing Address - Phone:269-584-0121
Mailing Address - Fax:
Practice Address - Street 1:7310 GARDEN LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4458
Practice Address - Country:US
Practice Address - Phone:269-459-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012645A363LF0000X
MI4704313314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily