Provider Demographics
NPI:1417305293
Name:BAKER, DANIELLE (APN)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:L
Other - Last Name:RENNIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 3988
Mailing Address - Street 2:1239 E. MAIN STREET
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901
Mailing Address - Country:US
Mailing Address - Phone:618-993-3817
Mailing Address - Fax:
Practice Address - Street 1:901 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:IL
Practice Address - Zip Code:62946-2640
Practice Address - Country:US
Practice Address - Phone:618-993-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-014195363LF0000X
IL277000421363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209014195-1Medicaid
ILF400317404OtherMEDICARE