Basic Information
| Provider Information | |||||||||
| NPI: | 1699753863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALDWIN | ||||||||
| FirstName: | E | ||||||||
| MiddleName: | LAWNEY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BALDWIN | ||||||||
| OtherFirstName: | ERROLL | ||||||||
| OtherMiddleName: | LAWNEY | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 GREENWAY CIR | ||||||||
| Address2: | |||||||||
| City: | ERWIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376502177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237433141 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 GREENWAY CIR | ||||||||
| Address2: | |||||||||
| City: | ERWIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376502177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237433141 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 12/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN0000010085 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 367500000X | RN0000109704 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 36258931 | 05 | TN | MEDICAID |