Provider Demographics
NPI:1619376563
Name:BAKER, LEE (CNA)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3673 W LAKE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3452
Mailing Address - Country:US
Mailing Address - Phone:814-566-8086
Mailing Address - Fax:
Practice Address - Street 1:3673 W LAKE RD APT 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3452
Practice Address - Country:US
Practice Address - Phone:814-566-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA10023441376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide