Provider Demographics
NPI:1598137002
Name:BAKER, CAROL JO (RD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JO
Last Name:BAKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21501 E POWERS CIR N
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-3365
Mailing Address - Country:US
Mailing Address - Phone:303-916-7023
Mailing Address - Fax:
Practice Address - Street 1:21501 E POWERS CIR N
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-3365
Practice Address - Country:US
Practice Address - Phone:303-866-7697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COR560869133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist