MEDICARE: ELIZABETH ANNE BAKER CNM

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	367A00000X	Advanced Practice Midwife	72000119A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000387100	OTHER	IN	ANTHEM BC/BS
2	0007218759	OTHER	IN	AETNA PIN

General Provider Information

NPI Number	:	1639262926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE BAKER CNM

Provider Business Mailing Address
First Line	:	8932 NORA WOODS DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1994
Country	:	US
Telephone Number	:	317-258-0356
Fax Number	:	317-844-5787

Provider Business Practice Location Address
First Line	:	836 E 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1806
Country	:	US
Telephone Number	:	317-258-0356
Fax Number	:	317-844-5787

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

Provider Enumeration Date	:	10/01/2006
Last Update Date	:	07/08/2007

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