MEDICARE: MR. PAUL DAVID BAKER ARNP

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	AP30004763	WA
2	363L00000X	Nurse Practitioner	AP30004763	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508868274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL DAVID BAKER ARNP

Provider Business Mailing Address
First Line	:	450 S KITSAP BLVD
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3773
Country	:	US
Telephone Number	:	360-874-5900
Fax Number	:	360-769-0614

Provider Business Practice Location Address
First Line	:	450 S KITSAP BLVD
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3773
Country	:	US
Telephone Number	:	360-874-5900
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/18/2021

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