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NPI Code Detail

MEDICARE: SHAWN BAKER RN, AGCNS-BC

MEDICARE: SHAWN BAKER RN, AGCNS-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse28161782AIN
2364SG0600XGerontology Clinical Nurse Specialist2015026491IN

General Provider Information

NPI Number : 1053864454
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN BAKER RN, AGCNS-BC
Provider Business Mailing Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-554-0000
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-554-0000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2016
Last Update Date : 08/02/2016

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