Provider Demographics
NPI:1831552462
Name:BAKER, AMY NICOLE (RN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14165 N FENTON RD
Mailing Address - Street 2:STE 102 B
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1587
Mailing Address - Country:US
Mailing Address - Phone:810-750-2713
Mailing Address - Fax:810-750-1261
Practice Address - Street 1:14165 N FENTON RD
Practice Address - Street 2:STE 102 B
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1587
Practice Address - Country:US
Practice Address - Phone:810-750-2713
Practice Address - Fax:810-750-1261
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704318712163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse