Healthcare Provider Details

I. General information

NPI: 1508476433
Provider Name (Legal Business Name): ELIZABETH SCOTT BAKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 CHURCH ST
CAMDEN SC
29020-3502
US

IV. Provider business mailing address

1116 CHURCH ST
CAMDEN SC
29020-3502
US

V. Phone/Fax

Practice location:
  • Phone: 803-425-6012
  • Fax:
Mailing address:
  • Phone: 803-425-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number254663
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: