Basic Information
Provider Information
NPI: 1265642953
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAKER
FirstName: JANICE
MiddleName: ELAINE
NamePrefix: MRS.
NameSuffix:  
Credential: NURSE PRACTITIONER
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4705 TOWNE CENTRE RD
Address2: STE 302
City: SAGINAW
State: MI
PostalCode: 486042819
CountryCode: US
TelephoneNumber: 9895834220
FaxNumber: 9895834287
Practice Location
Address1: 1447 N HARRISON ST
Address2:  
City: SAGINAW
State: MI
PostalCode: 486024727
CountryCode: US
TelephoneNumber: 9895834220
FaxNumber: 9895834287
Other Information
ProviderEnumerationDate: 05/23/2007
LastUpdateDate: 02/16/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X4704116344MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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