Provider Demographics
NPI:1881833820
Name:BAKER, LINDA M (ACNP-BC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 W. 10TH ST.
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-988-3630
Mailing Address - Fax:317-988-3159
Practice Address - Street 1:1481 W. 10TH ST.
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-988-3630
Practice Address - Fax:317-988-3159
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN281723074A163WM0705X
IN2008007629363LA2100X
SC17551363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA76458946OtherMEDICARE PTAN
SCNP1886Medicaid