Provider Demographics
NPI:1467630061
Name:BAKER, DEBORAH S (NP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:S
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 ENGLE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2234
Mailing Address - Country:US
Mailing Address - Phone:260-482-3886
Mailing Address - Fax:260-482-1910
Practice Address - Street 1:7230 ENGLE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2234
Practice Address - Country:US
Practice Address - Phone:260-482-3886
Practice Address - Fax:260-482-1910
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28103902A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201002220Medicaid