Provider Demographics
NPI:1659030088
Name:WOBIG-BAKER, TINA MARIE (RN, CCM)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:WOBIG-BAKER
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:BENNET
Mailing Address - State:NE
Mailing Address - Zip Code:68317-2419
Mailing Address - Country:US
Mailing Address - Phone:402-314-3723
Mailing Address - Fax:855-620-0975
Practice Address - Street 1:105 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BENNET
Practice Address - State:NE
Practice Address - Zip Code:68317-2419
Practice Address - Country:US
Practice Address - Phone:402-314-3723
Practice Address - Fax:855-620-0975
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60564462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty