Provider Demographics
NPI:1477320505
Name:BAKER, NASTASIA (PRS)
Entity Type:Individual
Prefix:
First Name:NASTASIA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 COLLINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-1140
Mailing Address - Country:US
Mailing Address - Phone:330-212-4623
Mailing Address - Fax:
Practice Address - Street 1:1178 COLLINWOOD AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-1140
Practice Address - Country:US
Practice Address - Phone:330-212-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.004614175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist