Provider Demographics
NPI:1467177733
Name:BAKER, SHAJOBA RENEE
Entity Type:Individual
Prefix:
First Name:SHAJOBA
Middle Name:RENEE
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 1:4050 GARDELLA AVE APT 118
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1029
Mailing Address - Country:US
Mailing Address - Phone:775-988-9100
Mailing Address - Fax:
Practice Address - Street 1:1575 DELUCCHI LN STE 218
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-8521
Practice Address - Country:US
Practice Address - Phone:775-682-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NV374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide