Provider Demographics
NPI:1023194123
Name:BAKER, NANCY D (PHD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:D
Last Name:BAKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-1935
Mailing Address - Country:US
Mailing Address - Phone:814-941-7188
Mailing Address - Fax:814-943-2022
Practice Address - Street 1:2229 BROAD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-1935
Practice Address - Country:US
Practice Address - Phone:814-941-7188
Practice Address - Fax:814-943-2022
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005735L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA659184Medicare PIN