Provider Demographics
NPI:1578229597
Name:BAKER, ETHEL MARIE (CNA)
Entity Type:Individual
Prefix:
First Name:ETHEL
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 CALICO CREEK CV
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7635
Mailing Address - Country:US
Mailing Address - Phone:501-515-0350
Mailing Address - Fax:
Practice Address - Street 1:5021 CALICO CREEK CV
Practice Address - Street 2:
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7635
Practice Address - Country:US
Practice Address - Phone:501-515-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider