1043436157 NPI number — MS. STACIE YVETTE BAKER LPN

Table of content: MS. STACIE YVETTE BAKER LPN (NPI 1043436157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043436157 NPI number — MS. STACIE YVETTE BAKER LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
STACIE
Provider Middle Name:
YVETTE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
STACIE
Provider Other Middle Name:
YVETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043436157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 SOUTH NEW ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABSECON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-892-3845
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 CONNECTICUT DRIVE
Provider Second Line Business Practice Location Address:
5
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-387-7322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  26NP05131800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)