Healthcare Provider Details

I. General information

NPI: 1497610786
Provider Name (Legal Business Name): RACHAEL BAKER CHW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 HILL ST
THREE RIVERS MI
49093-2724
US

IV. Provider business mailing address

4104 WATERVIEW DR
VICKSBURG MI
49097-1037
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-2161
  • Fax:
Mailing address:
  • Phone: 269-273-2161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number168937812
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: