Provider Demographics
NPI:1689950222
Name:BAKER, TANIA LEIGH (MA)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:LEIGH
Last Name:BAKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 AMORETTI ST
Mailing Address - Street 2:#8
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2759
Mailing Address - Country:US
Mailing Address - Phone:307-335-5173
Mailing Address - Fax:
Practice Address - Street 1:915 AMORETTI ST
Practice Address - Street 2:#8
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2759
Practice Address - Country:US
Practice Address - Phone:307-335-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor