Healthcare Provider Details

I. General information

NPI: 1518192640
Provider Name (Legal Business Name): MICHAELENE M BAKER URBAN MSNCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELENE M BAKER NP

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING B 86 OMEGA DRIVE
NEWARK DE
19713-6004
US

IV. Provider business mailing address

252 CHAPMAN RD SUITE 150
NEWARK DE
19702-5438
US

V. Phone/Fax

Practice location:
  • Phone: 302-366-7665
  • Fax: 302-366-0734
Mailing address:
  • Phone: 302-623-1929
  • Fax: 302-366-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberL90000104
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberLB0000270
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: