Healthcare Provider Details

I. General information

NPI: 1982000766
Provider Name (Legal Business Name): CARRIE R BAKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WAINEE ST STE 201
LAHAINA HI
96761-1589
US

IV. Provider business mailing address

3785 ELM DR
PEARL CITY HI
96782-3984
US

V. Phone/Fax

Practice location:
  • Phone: 808-280-4192
  • Fax: 877-273-2946
Mailing address:
  • Phone: 276-806-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1670
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: