Healthcare Provider Details

I. General information

NPI: 1770647661
Provider Name (Legal Business Name): MERIDITH BAKER PERRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MERIDITH ANN BAKER

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GREENWOOD AVE
CONWAY NH
03818-6130
US

IV. Provider business mailing address

7 GREENWOOD AVE
CONWAY NH
03818-6130
US

V. Phone/Fax

Practice location:
  • Phone: 603-447-3500
  • Fax:
Mailing address:
  • Phone: 850-881-2912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number077261-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP131108
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number180729
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: