Provider Demographics
NPI:1376997130
Name:BAKER, BRENDA LEA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:LEA
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17316 N KIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9686
Mailing Address - Country:US
Mailing Address - Phone:575-491-5367
Mailing Address - Fax:
Practice Address - Street 1:17316 N KIMBERLY WAY
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9686
Practice Address - Country:US
Practice Address - Phone:575-491-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02900363LF0000X
AZ229843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily