Provider Demographics
NPI:1801217740
Name:BAKER, NICOLE MICHELE (RDH, BS)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MICHELE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 COUNTRY CLUB RD STE C
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1754
Mailing Address - Country:US
Mailing Address - Phone:308-633-3368
Mailing Address - Fax:308-633-3371
Practice Address - Street 1:955 COUNTRY CLUB RD STE C
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1754
Practice Address - Country:US
Practice Address - Phone:308-633-3368
Practice Address - Fax:308-633-3371
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2070124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist