Basic Information
Provider Information
NPI: 1407265465
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BALDWIN
FirstName: SADIE
MiddleName: ANN SCHWENK
NamePrefix:  
NameSuffix:  
Credential: FNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 310 SUNNYVIEW LN
Address2:  
City: KALISPELL
State: MT
PostalCode: 599013129
CountryCode: US
TelephoneNumber: 4067525111
FaxNumber:  
Practice Location
Address1: 310 SUNNYVIEW LN
Address2:  
City: KALISPELL
State: MT
PostalCode: 599013129
CountryCode: US
TelephoneNumber: 4067525111
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/04/2014
LastUpdateDate: 08/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XNUR-RN-LIC-32291MTY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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