Healthcare Provider Details

I. General information

NPI: 1568895787
Provider Name (Legal Business Name): SUDI BAKER NP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2013
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 MAIN ST
MILLIS MA
02054-1612
US

IV. Provider business mailing address

171 MAIN ST STE 203B
ASHLAND MA
01721-1187
US

V. Phone/Fax

Practice location:
  • Phone: 508-376-2515
  • Fax: 508-376-9932
Mailing address:
  • Phone: 508-881-3029
  • Fax: 508-881-1752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269714
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: