Provider Demographics
NPI:1417010570
Name:BAKER, DRUCILLA F (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DRUCILLA
Middle Name:F
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DRUCILLA
Other - Middle Name:F
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1423 EAST 120TH STREET
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-229-9849
Mailing Address - Fax:216-231-5384
Practice Address - Street 1:18804 MAPLE HTS BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HTS
Practice Address - State:OH
Practice Address - Zip Code:44137
Practice Address - Country:US
Practice Address - Phone:216-355-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN036847163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health