Provider Demographics
NPI:1396188371
Name:BAKER, LYDIA (CD, CCCE)
Entity Type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CD, CCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 REEF PL
Mailing Address - Street 2:
Mailing Address - City:MALABAR
Mailing Address - State:FL
Mailing Address - Zip Code:32950-4631
Mailing Address - Country:US
Mailing Address - Phone:321-749-3252
Mailing Address - Fax:
Practice Address - Street 1:3505 REEF PL
Practice Address - Street 2:
Practice Address - City:MALABAR
Practice Address - State:FL
Practice Address - Zip Code:32950-4631
Practice Address - Country:US
Practice Address - Phone:321-749-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula