Provider Demographics
NPI:1285215541
Name:BAKER, BREANA LYNN (MSPA, PA-C)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N DYSART RD STE G127
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1011
Mailing Address - Country:US
Mailing Address - Phone:623-322-0323
Mailing Address - Fax:
Practice Address - Street 1:3400 N DYSART RD STE G127
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1011
Practice Address - Country:US
Practice Address - Phone:623-322-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ270848Medicaid