Healthcare Provider Details

I. General information

NPI: 1144559246
Provider Name (Legal Business Name): LISA M. BAKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 DOCTORS PARK STE 1
CAPE GIRARDEAU MO
63703-4903
US

IV. Provider business mailing address

1417 N. MOUNT AUBURN
CAPE GIRARDEAU MO
63701
US

V. Phone/Fax

Practice location:
  • Phone: 573-803-2941
  • Fax:
Mailing address:
  • Phone: 573-803-2941
  • Fax: 573-803-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013006307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: