Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704234211 | MI |
NPI | 1003369307 |
---|---|
Provider Name | Melissa Baker |
First Address | Garden City, MI 48135-1372 |
Second Address | Troy, MI 48098-2646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2016 |
Last Update Date | 03/08/2016 |