Provider Demographics
NPI:1760806087
Name:BAKER, CHARLENE
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
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 1:14110 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:44451-9616
Mailing Address - Country:US
Mailing Address - Phone:330-538-2257
Mailing Address - Fax:
Practice Address - Street 1:14110 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:NORTH JACKSON
Practice Address - State:OH
Practice Address - Zip Code:44451-9616
Practice Address - Country:US
Practice Address - Phone:330-538-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1215434163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse