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NPI Code Detail

MEDICARE: MARCI BAAK PLLC

MEDICARE: MARCI BAAK PLLC
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
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1407477474
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARCI BAAK PLLC
Provider Business Mailing Address
First Line : 819 E HUDSON AVE
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1609
Country : US
Telephone Number : 801-577-4003
Fax Number :
Provider Business Practice Location Address
First Line : 4624 S HOLLADAY BLVD STE 201
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84117-7168
Country : US
Telephone Number : 801-837-2600
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MARCI BAAK
Credential : NP
Telephone Number : 801-577-4003
Provider Enumeration Date : 05/01/2020
Last Update Date : 05/01/2020

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