Healthcare Provider Details

I. General information

NPI: 1508984345
Provider Name (Legal Business Name): LINDA SUSAN BAKER APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date: 03/06/2019
Reactivation Date: 03/12/2019

III. Provider practice location address

1529 EAGLE RIDGE DR NE
ALBUQUERQUE NM
87122-1151
US

IV. Provider business mailing address

210 VERDI DR. A
GALLUP NM
87301
US

V. Phone/Fax

Practice location:
  • Phone: 505-238-6757
  • Fax: 931-372-0234
Mailing address:
  • Phone: 505-979-6460
  • Fax: 931-372-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN7316
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN7316
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: