Healthcare Provider Details

I. General information

NPI: 1710390505
Provider Name (Legal Business Name): EMILY BAKER LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BAKER RD
ATHOL ID
83801-9228
US

IV. Provider business mailing address

76 BAKER RD
ATHOL ID
83801-9228
US

V. Phone/Fax

Practice location:
  • Phone: 208-610-3359
  • Fax:
Mailing address:
  • Phone: 208-610-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMID36
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: