Healthcare Provider Details

I. General information

NPI: 1669987657
Provider Name (Legal Business Name): JAMIE RYAN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE RYAN LINKUGEL

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 3014
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 3014
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.022328
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: