Healthcare Provider Details

I. General information

NPI: 1710439237
Provider Name (Legal Business Name): NICOLE MARIE BAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MONUMENT RD STE 1100
YORK PA
17403-5024
US

IV. Provider business mailing address

30 MONUMENT RD
YORK PA
17403-5024
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-6000
  • Fax: 717-851-3521
Mailing address:
  • Phone: 717-851-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066490
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601007915
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12509
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: