Provider Demographics
NPI:1730705989
Name:BALDERSON, DAVID BRIAN (NP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:BALDERSON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 RIVER VIEW AVE TRLR 88
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-5278
Mailing Address - Country:US
Mailing Address - Phone:715-540-0069
Mailing Address - Fax:
Practice Address - Street 1:2001 RIVER VIEW AVE TRLR 88
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5278
Practice Address - Country:US
Practice Address - Phone:715-540-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191927363LF0000X
WY55551363LF0000X
MI4704420389363LF0000X
MO2025008147363LF0000X
MT243896363LF0000X
WA61611209363LF0000X
IN71015843A363LF0000X
WI9884-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily