Healthcare Provider Details

I. General information

NPI: 1194827501
Provider Name (Legal Business Name): PHYLLIS ELIZABETH BAKER MSN, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 WEST 10TH STREET
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

1481 WEST 10TH STREET
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-2649
  • Fax: 317-988-2884
Mailing address:
  • Phone: 317-988-2649
  • Fax: 317-988-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number28085339A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number70000095A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: