Healthcare Provider Details

I. General information

NPI: 1801863733
Provider Name (Legal Business Name): MARJORIE C BAKER FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CHURCH ST
DEXTER ME
04930-1320
US

IV. Provider business mailing address

118 MOOSEHEAD TRL STE 5
NEWPORT ME
04953-4055
US

V. Phone/Fax

Practice location:
  • Phone: 207-924-5200
  • Fax: 207-924-5200
Mailing address:
  • Phone: 207-368-5189
  • Fax: 207-368-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP081448
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: