Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | XB0762799 | NH |
Y | 363L00000X | Nurse Practitioner | 036838-23 | NH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 036838-23-03 | NH |
NPI | 1689872335 |
---|---|
Provider Name | Judy Ann Baker |
First Address | Gorham, NH 03581-1506 |
Second Address | North Conway, NH 03860-5113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2007 |
Last Update Date | 18/08/2020 |