Healthcare Provider Details

I. General information

NPI: 1801305859
Provider Name (Legal Business Name): MCKENZIE BAKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 12/02/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 INDEPENDENCE AVE
AKRON OH
44310-1812
US

IV. Provider business mailing address

1590 11TH ST
CUYAHOGA FALLS OH
44221-4649
US

V. Phone/Fax

Practice location:
  • Phone: 234-312-2111
  • Fax:
Mailing address:
  • Phone: 330-790-1615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.393776
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021756
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: