Provider Demographics
NPI:1427227966
Name:BAKER, HOLLY NICOLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:NICOLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1649
Mailing Address - Country:US
Mailing Address - Phone:619-977-7408
Mailing Address - Fax:
Practice Address - Street 1:3131 N COUNTRY CLUB RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1649
Practice Address - Country:US
Practice Address - Phone:619-977-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11263171100000X
AZ0689171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist