Provider Demographics
NPI:1316933807
Name:BAKER, LAURIE A (DNP, RN, ANP-C)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:DNP, RN, ANP-C
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-3008
Mailing Address - Fax:602-406-6108
Practice Address - Street 1:3090 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-745-2954
Practice Address - Fax:602-745-2963
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN114181163W00000X
AZAP1284363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ686066Medicaid
P53667Medicare UPIN
AZ686066Medicaid