1972942571 NPI number — MRS. ANGELA MARIE BAKER LSW

Table of content: MRS. ANGELA MARIE BAKER LSW (NPI 1972942571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972942571 NPI number — MRS. ANGELA MARIE BAKER LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
ANGELA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972942571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1217 STONE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-4520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-972-1268
Provider Business Mailing Address Fax Number:
870-934-0847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2420 LINWOOD DR
Provider Second Line Business Practice Location Address:
SUITE #1 & 2
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450-6122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-236-5880
Provider Business Practice Location Address Fax Number:
870-236-5757
Provider Enumeration Date:
06/18/2013

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: 171M00000X , with the licence number:  3135-B , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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