Healthcare Provider Details

I. General information

NPI: 1861754830
Provider Name (Legal Business Name): SARAH BAKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DR STE 300
BALTIMORE MD
21209-3746
US

IV. Provider business mailing address

2700 QUARRY LAKE DR STE 300
BALTIMORE MD
21209-3746
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-8900
  • Fax: 410-377-0576
Mailing address:
  • Phone: 410-377-8900
  • Fax: 410-377-0576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR170058
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberTLRN038422
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: