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General NPI Number Information
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NPI Number | 1801217740
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Entity Type | Individual
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Provider Name | NICOLE MICHELE BAKER RDH, BS
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Gender | Female
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Dates
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Enumeration Date | 12/19/2013
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Last Update Date | 12/19/2013
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Provider Practice Location Address
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Address Line | 955 COUNTRY CLUB RD STE C
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City | GERING
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State | NE
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Zip | 69341-1754
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Country | US
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Telephone | 308-633-3368
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Fax | 308-633-3371
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Provider Business Mailing Address
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Address Line | 955 COUNTRY CLUB RD STE C
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City | GERING
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State | NE
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Zip | 69341-1754
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Country | US
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Telephone | 308-633-3368
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Fax | 308-633-3371
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2070
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License Number State | NE
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