Provider Demographics
NPI:1447808050
Name:BAKER, DESIREE NICOLE (LPN)
Entity type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:NICOLE
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 1:1515 CANFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4208
Mailing Address - Country:US
Mailing Address - Phone:937-813-5255
Mailing Address - Fax:
Practice Address - Street 1:1515 CANFIELD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4208
Practice Address - Country:US
Practice Address - Phone:937-813-5255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.165300.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty