Provider Demographics
NPI:1639547417
Name:BAKER, VIRGINIA ANN (MSN APN)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSN APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10933 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-7971
Mailing Address - Country:US
Mailing Address - Phone:815-690-5399
Mailing Address - Fax:
Practice Address - Street 1:5758 S MARYLAND AVE # MC9024
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:773-702-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010056364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist