Provider Demographics
NPI:1508886292
Name:BAKER, LAURA (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
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 1:59 CAPE HENRY TRL
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9677
Mailing Address - Country:US
Mailing Address - Phone:585-415-1759
Mailing Address - Fax:
Practice Address - Street 1:250 LUCIUS GORDON DR STE 2
Practice Address - Street 2:
Practice Address - City:WEST HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14586-9662
Practice Address - Country:US
Practice Address - Phone:585-471-3407
Practice Address - Fax:866-557-9530
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333407363LF0000X
NY404278363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02184494Medicaid
NY02184494Medicaid
NYRA9668Medicare PIN