Provider Demographics
NPI:1427717990
Name:BAKER, AUTUMN L (APRN)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 W SUNSET RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1981
Mailing Address - Country:US
Mailing Address - Phone:702-385-4342
Mailing Address - Fax:702-385-4346
Practice Address - Street 1:7150 W SUNSET RD STE 201A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1981
Practice Address - Country:US
Practice Address - Phone:702-385-4342
Practice Address - Fax:702-385-4346
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV848502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner