Provider Demographics
NPI:1043436157
Name:BAKER, STACIE YVETTE (LPN)
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:YVETTE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:STACIE
Other - Middle Name:YVETTE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:321 SOUTH NEW ROAD
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201
Mailing Address - Country:US
Mailing Address - Phone:609-892-3845
Mailing Address - Fax:
Practice Address - Street 1:261 CONNECTICUT DRIVE
Practice Address - Street 2:5
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:609-387-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05131800251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care