Provider Demographics
NPI:1255831863
Name:BAEZ, JUANA (LPN)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:BAEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 LIBERTY LN STE 210
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4949 LIBERTY LANE
Practice Address - Street 2:SUITE 210
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:610-866-3573
Practice Address - Fax:610-866-3573
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN273672164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102888687Medicaid