Provider Demographics
NPI:1912388786
Name:BAKER, BENJAMIN N (CRNA, DNP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:N
Last Name:BAKER
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Gender:M
Credentials:CRNA, DNP
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Mailing Address - Street 1:1515 DELHI STREET, SUITE 300
Mailing Address - Street 2:MISSISSIPPI VALLEY ANESTHESIOLOGY
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001
Mailing Address - Country:US
Mailing Address - Phone:563-557-5991
Mailing Address - Fax:563-589-4078
Practice Address - Street 1:1515 DELHI STREET, SUITE 300
Practice Address - Street 2:MISSISSIPPI VALLEY ANESTHESIOLOGY
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001
Practice Address - Country:US
Practice Address - Phone:563-557-5991
Practice Address - Fax:563-589-4078
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAD140842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered