Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 16390 | OH |
NPI | 1013300979 |
---|---|
Provider Name | Heather Baker |
First Address | Canton, OH 44710-1702 |
Second Address | Canton, OH 44710-1702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2015 |
Last Update Date | 16/03/2015 |