Provider Demographics
NPI:1235125345
Name:BAKER, DEBRA Q (RXN CNP CCRC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:Q
Last Name:BAKER
Suffix:
Gender:F
Credentials:RXN CNP CCRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3129
Mailing Address - Country:US
Mailing Address - Phone:719-471-3471
Mailing Address - Fax:719-471-0744
Practice Address - Street 1:140 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3129
Practice Address - Country:US
Practice Address - Phone:719-471-3471
Practice Address - Fax:719-471-0744
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47291363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP41563Medicare UPIN
COC445638Medicare PIN