Healthcare Provider Details

I. General information

NPI: 1043023559
Provider Name (Legal Business Name): IRIS H BAKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
HAMPTON VA
23665-2040
US

IV. Provider business mailing address

77 NEALY AVENUE
HAMPTON VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-2310
  • Fax:
Mailing address:
  • Phone: 757-225-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001148971
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001148971
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: