Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | COA.12506-NP | OH |
NPI | 1003198482 |
---|---|
Provider Name | Mrs. Janelle Jean Baldosser |
First Address | Marion, OH 43302-6397 |
Second Address | Bucyrus, OH 44820-1463 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2011 |
Last Update Date | 13/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36-0011 | (02) | |
5514803 | (05) | OH |