Healthcare Provider Details

I. General information

NPI: 1871588475
Provider Name (Legal Business Name): MAURA E BAKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PROFESSIONAL PARK RD
STORRS CT
06040
US

IV. Provider business mailing address

34 PROFESSIONAL PARK RD
STORRS CT
06040
US

V. Phone/Fax

Practice location:
  • Phone: 860-487-0002
  • Fax: 860-429-1663
Mailing address:
  • Phone: 860-487-0002
  • Fax: 860-429-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00320
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: