Provider Demographics
NPI:1215530944
Name:BAKER, KATHERINE JANE (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:JANE
Other - Last Name:NALEVANKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:57 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6093
Mailing Address - Country:US
Mailing Address - Phone:802-254-0252
Mailing Address - Fax:802-254-0253
Practice Address - Street 1:57 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6093
Practice Address - Country:US
Practice Address - Phone:802-254-0252
Practice Address - Fax:802-254-0253
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134658363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health