Individual
DANIELLE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
901 S COMMERCIAL ST, HARRISBURG, IL 62946-2640
(618) 993-3817
Mailing address
PO BOX 3988, 1239 E. MAIN STREET, CARBONDALE, IL 62901
(618) 993-3817
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
277000421
IL
363LF0000X
Family Nurse Practitioner
209-014195
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209014195-1
—
IL
01
—
F400317404
MEDICARE
IL
Enumeration date
06/02/2016
Last updated
03/14/2023
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