Provider Demographics
NPI:1801863733
Name:BAKER, MARJORIE C (FNPC)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:C
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:118 MOOSEHEAD TRL
Mailing Address - Street 2:STE 5
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-4055
Mailing Address - Country:US
Mailing Address - Phone:207-368-5189
Mailing Address - Fax:207-368-4213
Practice Address - Street 1:29 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1320
Practice Address - Country:US
Practice Address - Phone:207-924-5200
Practice Address - Fax:207-924-5200
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MEAP081448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME421300099Medicaid
Q31822Medicare UPIN
8ANP4858Medicare ID - Type Unspecified