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General NPI Number Information
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NPI Number | 1407144819
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Entity Type | Individual
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Provider Name | NORAH CLAIRE FARLEY BAKER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 03/17/2020
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Provider Practice Location Address
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Address Line | 10 PROFESSIONAL PARK DR.
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City | MARYVILLE
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State | IL
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Zip | 62062
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Country | US
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Telephone | 618-288-7244
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Fax | 618-288-1980
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Provider Business Mailing Address
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Address Line | 6810 STATE ROUTE 162 BOX 215
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City | MARYVILLE
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State | IL
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Zip | 62062-8501
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Country | US
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Telephone | 618-391-6405
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Fax | 618-288-4088
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-134056
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License Number State | IL
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