Provider Demographics
NPI:1629387394
Name:BAKER, KIMBERLY W (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:W
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E YEASTING ST
Mailing Address - Street 2:
Mailing Address - City:GIBSONBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43431-1420
Mailing Address - Country:US
Mailing Address - Phone:419-463-4859
Mailing Address - Fax:419-332-3048
Practice Address - Street 1:208 E YEASTING ST
Practice Address - Street 2:
Practice Address - City:GIBSONBURG
Practice Address - State:OH
Practice Address - Zip Code:43431-1420
Practice Address - Country:US
Practice Address - Phone:419-463-4859
Practice Address - Fax:419-332-3048
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN069688-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse