Healthcare Provider Details

I. General information

NPI: 1457700304
Provider Name (Legal Business Name): REBECCA BAKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 WOODLAWN ST
SHARON SC
29742-8779
US

IV. Provider business mailing address

2471 SUNSET MEADOW LN
SHARON SC
29742-8739
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 803-927-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20251
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: