Provider Demographics
NPI:1649252297
Name:BAKER, BRIDGETTE M (RNC, CNM, WHNP-C)
Entity type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:RNC, CNM, WHNP-C
Other - Prefix:
Other - First Name:BRIDGETTE
Other - Middle Name:M
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC, CNM, WHNP-C
Mailing Address - Street 1:1333 W 5TH ST, STE 110
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2752
Mailing Address - Country:US
Mailing Address - Phone:307-672-2522
Mailing Address - Fax:307-672-3732
Practice Address - Street 1:1333 W 5TH ST STE 210
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2752
Practice Address - Country:US
Practice Address - Phone:307-672-2522
Practice Address - Fax:307-672-3732
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12008.111367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110391101Medicaid
WY114080900Medicaid
WY12008.0111OtherSTATE LICENSE NUMBER
MT0437308Medicaid
WYMG0599805OtherDEA NUMBER
WY306051Medicare ID - Type Unspecified