MEDICARE: KATHLEEN G BAKER CRNP

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	363L00000X	Nurse Practitioner	TP003068C	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	440771	OTHER	RI	MLHC MEDICARE AA

General Provider Information

NPI Number	:	1679678825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN G BAKER CRNP

Provider Business Mailing Address
First Line	:	1 CONVENTION AVE
Second Line	:	4 PENN TOWER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4311
Country	:	US
Telephone Number	:	215-662-6488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CONVENTION AVE
Second Line	:	4 PENN TOWER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4311
Country	:	US
Telephone Number	:	215-662-6488
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	08/14/2015

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