Provider Demographics
NPI:1912236183
Name:BAALMAN, JACQUELINE SUE (FNP-BC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SUE
Last Name:BAALMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:LORSBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9203
Mailing Address - Country:US
Mailing Address - Phone:618-498-7518
Mailing Address - Fax:618-498-3052
Practice Address - Street 1:1 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5068
Practice Address - Country:US
Practice Address - Phone:314-996-4545
Practice Address - Fax:314-273-0140
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007954363LA2200X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205298003Medicare PIN
IL213122001Medicare PIN
IL204546001Medicare PIN
ILF400212796Medicare PIN
IL$$$$$$$$$001Medicaid