Provider Demographics
NPI:1821133000
Name:BAKER, KAREN MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 COUNTY ROUTE 20
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5673
Mailing Address - Country:US
Mailing Address - Phone:315-806-3452
Mailing Address - Fax:
Practice Address - Street 1:165 NORTH 5TH STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1229
Practice Address - Country:US
Practice Address - Phone:315-806-3452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2203991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01917422Medicaid