Basic Information
| Provider Information | |||||||||
| NPI: | 1083811400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WHALEN | ||||||||
| OtherFirstName: | COLLEEN | ||||||||
| OtherMiddleName: | DIANE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14011 BRUSH CREEK PL | ||||||||
| Address2: | |||||||||
| City: | ROCA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 684304403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14011 BRUSH CREEK PL | ||||||||
| Address2: | |||||||||
| City: | ROCA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 684304403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4023544000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2007 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 179-320 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 01080835A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2018029425 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 51797 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 15546 | ND | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 295094 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 64041 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 04-41692 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 11003 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | CDR.0000156 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD-45438 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 59150 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD22452 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301115893 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25564 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.