Provider Demographics
NPI:1073801445
Name:BAKER, KRISTEN L (RN, NP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 HOWARD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8313
Practice Address - Country:US
Practice Address - Phone:508-879-2250
Practice Address - Fax:508-620-2637
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN275705363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMB08462781OtherCONTROLLED SUBSTANCES REGISTRATION
MARN275705OtherSTATE LICENSE NUMBER