Provider Demographics
NPI:1689600751
Name:BAKER, NANCY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JEAN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2076 SAINT ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4543
Mailing Address - Country:US
Mailing Address - Phone:651-789-5031
Mailing Address - Fax:651-646-7884
Practice Address - Street 1:2076 SAINT ANTHONY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4543
Practice Address - Country:US
Practice Address - Phone:651-789-5031
Practice Address - Fax:651-646-7884
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP10065OtherHEALTHPARTNERS
IA1543637Medicaid
WI30711900Medicaid
MN1018772OtherPREFERRED ONE
MN1245501OtherARAZ
MN01-05736OtherMEDICA CHOICE
MN5867789 00Medicaid
MN107064OtherUCARE
MN39G60BAOtherBCBS
MN080190267Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI30711900Medicaid
MN1018772OtherPREFERRED ONE