Healthcare Provider Details

I. General information

NPI: 1477859346
Provider Name (Legal Business Name): ALICIA RENEE BAKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 MINNESOTA AVE NE
WASHINGTON DC
20019-2661
US

IV. Provider business mailing address

1220 12TH ST SE STE 120
WASHINGTON DC
20003-3733
US

V. Phone/Fax

Practice location:
  • Phone: 202-398-8683
  • Fax: 202-627-7815
Mailing address:
  • Phone: 202-398-8683
  • Fax: 202-627-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1006068
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1006068
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: