Provider Demographics
NPI:1265029813
Name:BAKER, MONICA DAWN
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DAWN
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 MAIN ST E APT 6 #143
Mailing Address - Street 2:
Mailing Address - City:MINNEWAUKAN
Mailing Address - State:ND
Mailing Address - Zip Code:58351-7515
Mailing Address - Country:US
Mailing Address - Phone:701-381-8069
Mailing Address - Fax:
Practice Address - Street 1:420 MAIN ST E APT 6
Practice Address - Street 2:
Practice Address - City:MINNEWAUKAN
Practice Address - State:ND
Practice Address - Zip Code:58351-7515
Practice Address - Country:US
Practice Address - Phone:701-381-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant