Healthcare Provider Details

I. General information

NPI: 1649096835
Provider Name (Legal Business Name): MEAGHAN ELIZABETH BAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 N MAIN ST
EAST LONGMEADOW MA
01028-1834
US

IV. Provider business mailing address

137 MAXWELL RD
MONSON MA
01057-9467
US

V. Phone/Fax

Practice location:
  • Phone: 413-525-1870
  • Fax:
Mailing address:
  • Phone: 413-636-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11240720
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: