Provider Demographics
NPI:1114513199
Name:BAKER, ROXANNE MARIE (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1968A KOMOHANA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5937
Mailing Address - Country:US
Mailing Address - Phone:808-451-7641
Mailing Address - Fax:
Practice Address - Street 1:1968A KOMOHANA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5937
Practice Address - Country:US
Practice Address - Phone:808-451-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-94109163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool