Provider Demographics
NPI:1467448126
Name:BAKER, SARA (RN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-1624
Mailing Address - Country:US
Mailing Address - Phone:269-273-5000
Mailing Address - Fax:269-273-8019
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-1624
Practice Address - Country:US
Practice Address - Phone:269-273-5000
Practice Address - Fax:269-273-8019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704219733163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708146Medicaid
MI1708146Medicaid