Provider Demographics
NPI:1871074021
Name:BAKER, SOPHIA
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
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 1:422 J J LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-6989
Mailing Address - Country:US
Mailing Address - Phone:985-415-1600
Mailing Address - Fax:
Practice Address - Street 1:422 J J LN
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-6989
Practice Address - Country:US
Practice Address - Phone:985-415-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2018-09-25
Deactivation Date:2018-09-14
Deactivation Code:
Reactivation Date:2018-09-25
Provider Licenses
StateLicense IDTaxonomies
LA94037313374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide