Healthcare Provider Details

I. General information

NPI: 1316933807
Provider Name (Legal Business Name): LAURIE A BAKER DNP, RN, ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE A POWELL

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 N 3RD AVE
PHOENIX AZ
85013
US

IV. Provider business mailing address

2910 N 3RD AVE
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 602-745-2954
  • Fax: 602-745-2963
Mailing address:
  • Phone: 602-406-3008
  • Fax: 602-406-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP1284
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN114181
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: