Provider Demographics
NPI:1235282500
Name:BAKER, MELISSA LYNN (LPN)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BARRINGER RD
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-4302
Mailing Address - Country:US
Mailing Address - Phone:315-717-7893
Mailing Address - Fax:
Practice Address - Street 1:232 BARRINGER RD
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-4302
Practice Address - Country:US
Practice Address - Phone:315-717-7893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270284-1164W00000X
NY270284164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02390536Medicaid