MEDICARE: MRS. AMANDA DIANE BAKER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-022229	AL

General Provider Information

NPI Number	:	1184661480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA DIANE BAKER FNP-C

Provider Business Mailing Address
First Line	:	8555 CARRINGTON LAKE CRST
Second Line	:
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-3802
Country	:	US
Telephone Number	:	205-655-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 6TH AVENUE SOUTH
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-0001
Country	:	US
Telephone Number	:	205-996-6870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	02/13/2008

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