Provider Demographics
NPI:1427417146
Name:BAKER, LOUISE ELIZABETH
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:ELIZABETH
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 1:1629 W WHITMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9452
Mailing Address - Country:US
Mailing Address - Phone:209-537-5221
Mailing Address - Fax:209-531-0233
Practice Address - Street 1:1629 W WHITMORE AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-9452
Practice Address - Country:US
Practice Address - Phone:209-537-5221
Practice Address - Fax:209-531-0233
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor