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General NPI Number Information
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NPI Number | 1922566744
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Entity Type | Individual
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Provider Name | LACEY J BAKER PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 569 32 RD STE 12
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City | GRAND JUNCTION
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State | CO
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Zip | 81504-6095
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Country | US
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Telephone | 970-523-3544
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Fax | 970-249-5029
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Provider Business Mailing Address
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Address Line | 2303 S TOWNSEND AVE STE A
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City | MONTROSE
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State | CO
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Zip | 81401-5452
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Country | US
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Telephone | 970-249-7751
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Fax | 970-249-5029
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.0007059
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License Number State | CO
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