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NPI Code Detail

MEDICARE: PENNY L BAKER RDN

MEDICARE: PENNY L BAKER RDN
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
1133V00000XRegistered DietitianND159FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1N0146OTHERFLBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1700827276
Entity Type Code : Individual
Provider Name (Legal Business Name) : PENNY L BAKER RDN
Provider Business Mailing Address
First Line : 4600 ROSEWOOD TREE CT APT B
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33436-1237
Country : US
Telephone Number : 561-601-2965
Fax Number :
Provider Business Practice Location Address
First Line : 4600 ROSEWOOD TREE CT APT B
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33436-1237
Country : US
Telephone Number : 561-601-2965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 09/12/2023

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