Provider Demographics
NPI:1902022494
Name:BAKER, PATRICIA LOUISE (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LOUISE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:LOUISE
Other - Last Name:BAKER-BORDIGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2 FULLERTON LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 LYNCH CREEK WAY STE C
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2390
Practice Address - Country:US
Practice Address - Phone:707-763-0802
Practice Address - Fax:707-763-0803
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant