Provider Demographics
NPI:1629498423
Name:BAKER, AMANDA RAE (CRNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:BAKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:RAE
Other - Last Name:CALHOUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2333 KEARNEY RD
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824-5739
Mailing Address - Country:US
Mailing Address - Phone:814-265-2590
Mailing Address - Fax:
Practice Address - Street 1:33 BEAVER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2434
Practice Address - Country:US
Practice Address - Phone:814-503-8070
Practice Address - Fax:814-503-8531
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013814363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA356677FFUMedicare PIN