Healthcare Provider Details

I. General information

NPI: 1679247522
Provider Name (Legal Business Name): JEFFREY PHILIP BAKER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 S 86TH ST STE 101
LINCOLN NE
68526-9261
US

IV. Provider business mailing address

4333 S 86TH ST STE 101
LINCOLN NE
68526-9261
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-6343
  • Fax: 402-483-8501
Mailing address:
  • Phone: 402-483-6343
  • Fax: 402-483-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113695
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: