Provider Demographics
NPI:1760837975
Name:BAKER, LORI (F-CNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:F-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 BOTECELLI CT
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-7678
Mailing Address - Country:US
Mailing Address - Phone:304-839-7325
Mailing Address - Fax:
Practice Address - Street 1:1804 W KING ST
Practice Address - Street 2:SUITES 300-400
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2031
Practice Address - Country:US
Practice Address - Phone:304-262-4525
Practice Address - Fax:304-262-4205
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39047174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019737Medicaid