Basic Information
Provider Information
NPI: 1356303010
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAKER
FirstName: DEBORAH
MiddleName: LYNN
NamePrefix: MS.
NameSuffix:  
Credential: NURSE PRACTITIONER
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5419 MASEFIELD RD
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212291019
CountryCode: US
TelephoneNumber: 4107442809
FaxNumber: 4106057912
Practice Location
Address1: VAMC-BALTIMORE
Address2: 10 NORTH GREENE STREET
City: BALTIMORE
State: MD
PostalCode: 21201
CountryCode: US
TelephoneNumber: 4106057000
FaxNumber: 4106057912
Other Information
ProviderEnumerationDate: 04/06/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XRO62530MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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