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General NPI Number Information
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NPI Number | 1518025360
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Entity Type | Individual
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Provider Name | SHANNON COOKE BAKER M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 2655 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-8542
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Country | US
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Telephone | 801-256-6343
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Fax | 801-256-6367
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Provider Business Mailing Address
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Address Line | 2655 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-8542
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Country | US
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Telephone | 801-256-6343
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Fax | 801-256-6367
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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 | M7024
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License Number State | TX
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