Healthcare Provider Details

I. General information

NPI: 1962763268
Provider Name (Legal Business Name): JEANNETTE ELISABETH BAKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST 454AR2
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST 454AR2
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-4589
  • Fax: 802-847-4918
Mailing address:
  • Phone: 802-847-4589
  • Fax: 802-847-4918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1010086056
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101-0086056
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: