Provider Demographics
NPI:1710273610
Name:BAKER, ANDREA MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MONIQUE
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1631-A EAST HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-5769
Mailing Address - Country:US
Mailing Address - Phone:405-262-7631
Mailing Address - Fax:405-262-8099
Practice Address - Street 1:1631-A
Practice Address - Street 2:EAST HIGHWAY 66
Practice Address - City:ELRENO
Practice Address - State:OK
Practice Address - Zip Code:73036-5769
Practice Address - Country:US
Practice Address - Phone:405-262-7631
Practice Address - Fax:405-262-8099
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29463163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health