1588093090 NPI number — MRS. LORENA ELAINE KENDRICKS-BAKER MS. MFT

Table of content: MRS. LORENA ELAINE KENDRICKS-BAKER MS. MFT (NPI 1588093090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588093090 NPI number — MRS. LORENA ELAINE KENDRICKS-BAKER MS. MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENDRICKS-BAKER
Provider First Name:
LORENA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS. MFT
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:
1588093090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7345 S DURANGO DR
Provider Second Line Business Mailing Address:
# B107-371
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89113-3653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-672-2549
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7345 S DURANGO DR
Provider Second Line Business Practice Location Address:
# B107-371
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89113-3653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-672-2549
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2013

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: 106H00000X , with the licence number:  MI0411 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com