Provider Demographics
NPI:1508639816
Name:BAKER, SAMANTHA LAUREN (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:LAUREN
Last Name:BAKER
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 WEAVER PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3864
Mailing Address - Country:US
Mailing Address - Phone:630-839-9199
Mailing Address - Fax:
Practice Address - Street 1:4580 WEAVER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3864
Practice Address - Country:US
Practice Address - Phone:630-839-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.028937363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health