Provider Demographics
NPI:1790375962
Name:BAKER, LISA M (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N WILMOT RD STE 340
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2607
Mailing Address - Country:US
Mailing Address - Phone:520-214-3960
Mailing Address - Fax:520-336-9199
Practice Address - Street 1:333 N WILMOT RD STE 340
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2607
Practice Address - Country:US
Practice Address - Phone:520-214-3960
Practice Address - Fax:520-336-9199
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61098480363LP0808X
MTAPRN-174376363LP0808X
AZ251803363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health