Provider Demographics
NPI:1043649734
Name:BAKER, LASHAWN DENISE
Entity type:Individual
Prefix:MS
First Name:LASHAWN
Middle Name:DENISE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 S 76TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-6628
Mailing Address - Country:US
Mailing Address - Phone:918-277-4233
Mailing Address - Fax:
Practice Address - Street 1:4961 S 76TH EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-6628
Practice Address - Country:US
Practice Address - Phone:918-277-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK232567Medicare UPIN