Healthcare Provider Details

I. General information

NPI: 1508886292
Provider Name (Legal Business Name): LAURA BAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/09/2023
Certification Date: 09/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 LUCIUS GORDON DR STE 2
WEST HENRIETTA NY
14586-9662
US

IV. Provider business mailing address

59 CAPE HENRY TRL
WEST HENRIETTA NY
14586-9677
US

V. Phone/Fax

Practice location:
  • Phone: 585-471-3407
  • Fax: 866-557-9530
Mailing address:
  • Phone: 585-415-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333407
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404278
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: