Healthcare Provider Details

I. General information

NPI: 1750257978
Provider Name (Legal Business Name): MEGAN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

IV. Provider business mailing address

5223 HAGUE CT
COEUR D ALENE ID
83815-8592
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-6625
  • Fax:
Mailing address:
  • Phone: 208-819-2084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8371586
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8371586
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: