Provider Demographics
NPI:1477285559
Name:BAKER, TABITHA (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-1112
Mailing Address - Country:US
Mailing Address - Phone:205-441-8106
Mailing Address - Fax:
Practice Address - Street 1:2100 BEVERLY HILLS DR
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1704
Practice Address - Country:US
Practice Address - Phone:205-441-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-155551163W00000X
ALL-307417163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse