=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306558465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE-BLANCHE TATKEU BAKER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2022
-----------------------------------------------------
Last Update Date | 12/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1715 NEWTON ST NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20018-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-526-1675
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13805 DAWN WHISTLE WAY
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-1226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-454-4234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | NP1038654
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------