Provider Demographics
NPI:1922421957
Name:BAKER, TIMMAREA LASHAY (LPN)
Entity Type:Individual
Prefix:
First Name:TIMMAREA
Middle Name:LASHAY
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 1:6780 MAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1320
Mailing Address - Country:US
Mailing Address - Phone:937-716-5046
Mailing Address - Fax:
Practice Address - Street 1:6780 MAD RIVER RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-1320
Practice Address - Country:US
Practice Address - Phone:937-716-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.154188-M-IV164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse