Healthcare Provider Details

I. General information

NPI: 1184031288
Provider Name (Legal Business Name): STEPHANIE BAKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 ROSE LN
WICKENBURG AZ
85390-1447
US

IV. Provider business mailing address

2303 HUNTINGTON LN
REDONDO BEACH CA
90278-4412
US

V. Phone/Fax

Practice location:
  • Phone: 480-420-4027
  • Fax: 602-535-0940
Mailing address:
  • Phone: 610-350-8412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRN598141
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101.0106204
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number254534
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: