Healthcare Provider Details

I. General information

NPI: 1679524896
Provider Name (Legal Business Name): SHAWNA BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

IV. Provider business mailing address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4000
  • Fax: 701-456-4800
Mailing address:
  • Phone: 701-456-4000
  • Fax: 701-456-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8002
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14756
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: