Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 5014140 | NC |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 261459 | NC |
NPI | 1073106258 |
---|---|
Provider Name | Crystal Leigh Baker |
First Address | Tarboro, NC 27886-1935 |
Second Address | Tarboro, NC 27886-1935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2021 |
Last Update Date | 11/03/2021 |