Provider Demographics
NPI:1033449921
Name:BAKER, SUSAN RENE' (APRN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RENE'
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N ALMA DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3359
Mailing Address - Country:US
Mailing Address - Phone:972-720-3333
Mailing Address - Fax:469-730-4009
Practice Address - Street 1:105 N ALMA DR STE 300
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3359
Practice Address - Country:US
Practice Address - Phone:972-720-3333
Practice Address - Fax:469-730-4009
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113192363LP0200X
TX653558363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics