Provider Demographics
NPI:1548316276
Name:BAKER, MARY ANNE (CNM)
Entity type:Individual
Prefix:MS
First Name:MARY ANNE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:949 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1254
Mailing Address - Country:US
Mailing Address - Phone:978-283-0942
Mailing Address - Fax:
Practice Address - Street 1:19 BROADWAY
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4417
Practice Address - Country:US
Practice Address - Phone:978-922-4490
Practice Address - Fax:978-922-5904
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169993367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA711452OtherTUFTS
MAAA8482OtherHARVARD PILGRIM
MAAA8482OtherHARVARD PILGRIM