Provider Demographics
NPI:1760814446
Name:BAKER, HEATHER (CRNA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:GEHRKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2914 S REPUBLIC BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1912
Mailing Address - Country:US
Mailing Address - Phone:419-531-8808
Mailing Address - Fax:419-531-9342
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-531-8808
Practice Address - Fax:419-531-9342
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN393173367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered