Healthcare Provider Details

I. General information

NPI: 1174509764
Provider Name (Legal Business Name): CHERRY BAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CLEMENT WAY
BELGRADE ME
04917-4370
US

IV. Provider business mailing address

PO BOX 284
BRATTLEBORO VT
05302-0284
US

V. Phone/Fax

Practice location:
  • Phone: 207-495-3323
  • Fax:
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR017604
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP081495
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: