Provider Demographics
NPI:1497770861
Name:BAKER, DEBORAH R (LRD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:LRD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BELKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075
Mailing Address - Country:US
Mailing Address - Phone:701-642-7000
Mailing Address - Fax:701-642-7055
Practice Address - Street 1:332 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58075-4528
Practice Address - Country:US
Practice Address - Phone:701-642-7000
Practice Address - Fax:701-642-7055
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND695132700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51169Medicaid
ND51169Medicaid