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Individual

BRIAN BAKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1 MEDICAL VILLAGE DR, EDGEWOOD, KY 41017-3403
(859) 301-2211
Mailing address
512 CALUMET CT, FORT THOMAS, KY 41075-4033

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1144275
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
1144275
KY

Other

Enumeration date
10/16/2017
Last updated
01/02/2018
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