MEDICARE: MRS. LISA M. BAKER FNP-C

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
1	363LF0000X	Family Nurse Practitioner	2013006307	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2013006703	OTHER	MO	LICENSE NUMBER

General Provider Information

NPI Number	:	1144559246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA M. BAKER FNP-C

Provider Business Mailing Address
First Line	:	1417 N. MOUNT AUBURN
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701
Country	:	US
Telephone Number	:	573-803-2941
Fax Number	:	573-803-0815

Provider Business Practice Location Address
First Line	:	37 DOCTORS PARK STE 1
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4903
Country	:	US
Telephone Number	:	573-803-2941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2009
Last Update Date	:	11/13/2017

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