Provider Demographics
NPI:1831469139
Name:BAKER, ANDREA (CRNA, DNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CRNA, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 SATELLITE BLVD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1290
Mailing Address - Country:US
Mailing Address - Phone:404-785-8000
Mailing Address - Fax:404-785-8001
Practice Address - Street 1:2620 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1290
Practice Address - Country:US
Practice Address - Phone:404-785-8000
Practice Address - Fax:404-785-8001
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238301367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX289948601Medicaid
TX289948601Medicaid