Provider Demographics
NPI:1689872335
Name:BAKER, JUDY ANN (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HIGHLAND AVE
Mailing Address - Street 2:P.O. BOX 135
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1506
Mailing Address - Country:US
Mailing Address - Phone:160-346-6366
Mailing Address - Fax:
Practice Address - Street 1:3277 WHITE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:NORTH CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03860-5113
Practice Address - Country:US
Practice Address - Phone:603-356-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHXB0762799207QA0401X
NH036838-23-03363LF0000X
NH036838-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily