Provider Demographics
NPI:1902080013
Name:BALDACCI, ANTHONY EUGENE (MSN, ANP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:EUGENE
Last Name:BALDACCI
Suffix:
Gender:M
Credentials:MSN, ANP
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:BALDACCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN, ANP
Mailing Address - Street 1:1836 MEADE STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459
Mailing Address - Country:US
Mailing Address - Phone:541-808-0430
Mailing Address - Fax:
Practice Address - Street 1:1836 MEADE STREET
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-808-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648845163W00000X
OR200742895RN163W00000X
OR200850023NP363LA2200X
CA18025363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
R120353OtherPTAN
OR213342Medicaid
OR1619915113OtherCLINIC GROUP NPI
OR1619915113OtherCLINIC GROUP NPI
MB1738888OtherDEA
R141981Medicare PIN