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General NPI Number Information
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NPI Number | 1093539306
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Entity Type | Individual
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Provider Name | JEREMY BAKER DNP, PMHNP
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1603 E 9 MILE RD
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City | FERNDALE
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State | MI
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Zip | 48220-2065
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Country | US
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Telephone | 248-514-4955
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Fax |
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Provider Business Mailing Address
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Address Line | 291 CHESTERFIELD AVE
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City | BIRMINGHAM
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State | MI
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Zip | 48009-1284
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704404508
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License Number State | MI
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