Healthcare Provider Details

I. General information

NPI: 1740736156
Provider Name (Legal Business Name): TARRA LEANI BAKER MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2016
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 FAIRVIEW AVE SE
SALEM OR
97302-2534
US

IV. Provider business mailing address

PO BOX 4060
SALEM OR
97302-1060
US

V. Phone/Fax

Practice location:
  • Phone: 971-239-1146
  • Fax:
Mailing address:
  • Phone: 971-239-1146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number210180
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201701173NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number21994
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201701172RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: