Healthcare Provider Details

I. General information

NPI: 1003050808
Provider Name (Legal Business Name): KATHERYN ANN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERYN ANN BAKER RN

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 GARRISONWAY
FRUITLAND MD
21826
US

IV. Provider business mailing address

C CO 302 BSB ATTN: TMC UNIT 15609
APO AP
96224
US

V. Phone/Fax

Practice location:
  • Phone: 502-413-5841
  • Fax:
Mailing address:
  • Phone: 502-413-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR121393
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: