Healthcare Provider Details

I. General information

NPI: 1477729937
Provider Name (Legal Business Name): MICHELLE RUTH BAKER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 W GENESEE ST
SYRACUSE NY
13219-1542
US

IV. Provider business mailing address

2703 W GENESEE ST
SYRACUSE NY
13219-1542
US

V. Phone/Fax

Practice location:
  • Phone: 315-487-9285
  • Fax:
Mailing address:
  • Phone: 315-487-9285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number560169-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: