Provider Demographics
NPI:1669106332
Name:BAKER, AMANDA JANIS (FNP-C)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JANIS
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 E HUNDRED RD STE 104
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3310
Mailing Address - Country:US
Mailing Address - Phone:804-681-0556
Mailing Address - Fax:804-410-4619
Practice Address - Street 1:1714 E HUNDRED RD STE 104
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3310
Practice Address - Country:US
Practice Address - Phone:804-681-0556
Practice Address - Fax:804-410-4619
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001288819163WG0100X
VA0024184971363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterologyGroup - Single Specialty