Provider Demographics
NPI:1619274404
Name:BAKER, KIRSTEN
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:IA
Mailing Address - Zip Code:50702-6063
Mailing Address - Country:US
Mailing Address - Phone:319-296-2222
Mailing Address - Fax:
Practice Address - Street 1:326 4TH ST
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:IA
Practice Address - Zip Code:50702-6063
Practice Address - Country:US
Practice Address - Phone:319-296-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse