Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP118496 | TX |
NPI | 1205212198 |
---|---|
Provider Name | Tracey Baker |
First Address | Webster, TX 77598-4220 |
Second Address | Webster, TX 77598-4220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2015 |
Last Update Date | 03/08/2015 |