Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 28220234A | IN |
NPI | 1760011605 |
---|---|
Provider Name | Chrissy Jo Baker |
First Address | Cloverdale, IN 46120-0093 |
Second Address | Indianapolis, IN 46234-9016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2020 |
Last Update Date | 03/04/2020 |