Provider Demographics
NPI:1891296216
Name:BAKER, EVEVISHA
Entity Type:Individual
Prefix:
First Name:EVEVISHA
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 1:9735 GOOD LUCK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3317
Mailing Address - Country:US
Mailing Address - Phone:410-300-6764
Mailing Address - Fax:
Practice Address - Street 1:9735 GOOD LUCK RD APT 3
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3317
Practice Address - Country:US
Practice Address - Phone:410-300-6764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant