=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760452627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INEZ A BAKER-WESTBROCK WHCNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1965 FORD PKWY 1165 ARCADE ST ST. PAUL MN 55106
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55116-1923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-698-2406
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9530 JOSHUA CT
-----------------------------------------------------
City | CHISAGO CITY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55013-9781
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-257-9454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | R081312-9
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------