Provider Demographics
NPI:1659268134
Name:BAKER, SHANTRINA MICHELLE
Entity type:Individual
Prefix:
First Name:SHANTRINA
Middle Name:MICHELLE
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 1:13166 SIERRA BLANCA WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7224
Mailing Address - Country:US
Mailing Address - Phone:928-216-1877
Mailing Address - Fax:
Practice Address - Street 1:13166 SIERRA BLANCA WAY
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-7224
Practice Address - Country:US
Practice Address - Phone:928-216-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant