Provider Demographics
NPI:1093157380
Name:BAKER, JASON MATTHEW (LPN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:BAKER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:IA
Mailing Address - Zip Code:50055-7747
Mailing Address - Country:US
Mailing Address - Phone:641-385-2088
Mailing Address - Fax:
Practice Address - Street 1:403 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:IA
Practice Address - Zip Code:50055-7747
Practice Address - Country:US
Practice Address - Phone:641-385-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAPM-99-506-11146L00000X
IAP51719164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No164W00000XNursing Service ProvidersLicensed Practical Nurse