Provider Demographics
NPI:1922044593
Name:BAKER, EILEEN T (CRNA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:T
Last Name:BAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-1849
Mailing Address - Country:US
Mailing Address - Phone:903-677-1000
Mailing Address - Fax:903-677-5586
Practice Address - Street 1:4002 S LOOP 256
Practice Address - Street 2:SUITE N
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8491
Practice Address - Country:US
Practice Address - Phone:903-677-1000
Practice Address - Fax:903-677-5586
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869233367500000X
TX254696367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89762UOtherBLUECROSS BLUE SHIELD
MS01674381Medicaid
TX130162413Medicaid
TX8F7553Medicare PIN
TX130162413Medicaid
TX8L7614Medicare PIN
MS430001885Medicare PIN
TX89762UOtherBLUECROSS BLUE SHIELD