Provider Demographics
NPI:1518192640
Name:BAKER URBAN, MICHAELENE M (MSNCNS)
Entity Type:Individual
Prefix:
First Name:MICHAELENE
Middle Name:M
Last Name:BAKER URBAN
Suffix:
Gender:F
Credentials:MSNCNS
Other - Prefix:
Other - First Name:MICHAELENE
Other - Middle Name:M
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:252 CHAPMAN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5438
Mailing Address - Country:US
Mailing Address - Phone:302-623-1929
Mailing Address - Fax:302-366-1075
Practice Address - Street 1:BUILDING B 86
Practice Address - Street 2:OMEGA DRIVE
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6004
Practice Address - Country:US
Practice Address - Phone:302-366-7665
Practice Address - Fax:302-366-0734
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL90000104364S00000X
DELB0000270363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DELB0000270OtherLICENSE
DEL90000104OtherLICENSE