MEDICARE: AMBER LEE BAINES RN

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	163W00000X	Registered Nurse	976504	TX
2	2279G1100X	General Care Registered Respiratory Therapist	L0005579	MD
3	363LF0000X	Family Nurse Practitioner	1052398	TX

General Provider Information

NPI Number	:	1699011270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LEE BAINES RN

Provider Business Mailing Address
First Line	:	25710 LONG HILL LN
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77373-9109
Country	:	US
Telephone Number	:	443-447-3428
Fax Number	:

Provider Business Practice Location Address
First Line	:	1944 W GRAY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-4826
Country	:	US
Telephone Number	:	832-742-9695
Fax Number	:

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

Provider Enumeration Date	:	12/29/2012
Last Update Date	:	01/11/2022

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