Provider Demographics
NPI:1508324609
Name:BAKER, SEAN ALBERT (RN)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:ALBERT
Last Name:BAKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 MARTIN DR APT 4206
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6284
Mailing Address - Country:US
Mailing Address - Phone:630-212-3475
Mailing Address - Fax:
Practice Address - Street 1:1720 MARTIN DR APT 4206
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6284
Practice Address - Country:US
Practice Address - Phone:630-212-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX960126163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse