Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN1007058 | DC |
NPI | 1043370323 |
---|---|
Provider Name | Stacey L Merritt Baker |
First Address | Annandale, VA 22003-6107 |
Second Address | Annandale, VA 22003-6107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2006 |
Last Update Date | 30/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q63780 | (02) |