MEDICARE: NATALIE BAKER

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1538709001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE BAKER

Provider Business Mailing Address
First Line	:	PO BOX 32
Second Line	:
City	:	LA VERNIA
State	:	TX
Zip	:	78121-0032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3698 CHAMBERS PASS BLDG 3611
Second Line	:
City	:	JBSA FT SAM HOUSTON
State	:	TX
Zip	:	78234-7766
Country	:	US
Telephone Number	:	210-916-5658
Fax Number	:

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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