Healthcare Provider Details

I. General information

NPI: 1497018527
Provider Name (Legal Business Name): REBECCA MARIE BAKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8787
  • Fax: 513-874-4579
Mailing address:
  • Phone: 513-475-8787
  • Fax: 513-874-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17526-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: