Healthcare Provider Details

I. General information

NPI: 1881214559
Provider Name (Legal Business Name): MELANIE BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 INDIAN SCHOOL RD NE STE A
ALBUQUERQUE NM
87110-4504
US

IV. Provider business mailing address

7301 INDIAN SCHOOL RD NE STE A
ALBUQUERQUE NM
87110-4504
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-0441
  • Fax: 801-459-1200
Mailing address:
  • Phone: 505-362-2326
  • Fax: 52-660-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM11262
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: