MEDICARE: MARIA 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	163W00000X	Registered Nurse	28241255A	IN
2	363L00000X	Nurse Practitioner	71015580A	IN
3	363LA2200X	Adult Health Nurse Practitioner	F01240836	IN

General Provider Information

NPI Number	:	1790531317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BAKER FNP-C

Provider Business Mailing Address
First Line	:	4404 VIVA LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-1910
Country	:	US
Telephone Number	:	317-727-6007
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 VIVA LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-1910
Country	:	US
Telephone Number	:	317-727-6007
Fax Number	:

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

Provider Enumeration Date	:	04/25/2024
Last Update Date	:	03/12/2026

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