Provider Demographics
NPI:1447859616
Name:BAKER, LISA MICHELLE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
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:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:OH
Mailing Address - Zip Code:43080-0938
Mailing Address - Country:US
Mailing Address - Phone:740-405-4998
Mailing Address - Fax:
Practice Address - Street 1:606 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:OH
Practice Address - Zip Code:43080-9700
Practice Address - Country:US
Practice Address - Phone:740-405-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle