Provider Demographics
NPI:1639850241
Name:BAKER, KATHLEEN ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2768 LONGFORD DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2235
Mailing Address - Country:US
Mailing Address - Phone:408-219-3748
Mailing Address - Fax:408-358-0012
Practice Address - Street 1:14911 NATIONAL AVE STE 7
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2632
Practice Address - Country:US
Practice Address - Phone:408-358-3511
Practice Address - Fax:408-358-0012
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95205391163WG0000X, 163WA2000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95205391OtherCALIFORNIA BOARD OF REGISTERED NURSING