Healthcare Provider Details

I. General information

NPI: 1407477474
Provider Name (Legal Business Name): MARCI BAAK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4624 S HOLLADAY BLVD STE 201
SALT LAKE CITY UT
84117-7168
US

IV. Provider business mailing address

819 E HUDSON AVE
SALT LAKE CITY UT
84106-1609
US

V. Phone/Fax

Practice location:
  • Phone: 801-837-2600
  • Fax:
Mailing address:
  • Phone: 801-577-4003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARCI BAAK
Title or Position: OWNER
Credential: NP
Phone: 801-577-4003