Individual
MR. ANTHONY EUGENE BALDACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.N., ANP
Contact information
Practice address
1836 MEADE STREET, NORTH BEND, OR 97459
(541) 808-0430
Mailing address
1836 MEADE STREET, NORTH BEND, OR 97459
(541) 808-0430
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200742895RN
OR
163W00000X
Registered Nurse
648845
CA
363LA2200X
Adult Health Nurse Practitioner
18025
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
200850023NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619915113
CLINIC GROUP NPI
OR
05
—
213342
—
OR
01
—
R120353
PTAN
—
Enumeration date
12/26/2007
Last updated
03/07/2023
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