Provider Demographics
NPI:1003020322
Name:BAKER, RONALD GLEN (APNP)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:GLEN
Last Name:BAKER
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WALKINS CT
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-6406
Mailing Address - Country:US
Mailing Address - Phone:715-341-1304
Mailing Address - Fax:
Practice Address - Street 1:910 FREMONT ST
Practice Address - Street 2:UWSP HEALTH SERVICE
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3105
Practice Address - Country:US
Practice Address - Phone:715-346-4317
Practice Address - Fax:715-346-4752
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI863033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43851000Medicaid
WI43851000Medicaid