Provider Demographics
NPI:1003050808
Name:BAKER, KATHERYN ANN
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:ANN
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERYN
Other - Middle Name:ANN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:C CO 302 BSB ATTN: TMC
Mailing Address - Street 2:UNIT 15609
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96224
Mailing Address - Country:US
Mailing Address - Phone:502-413-5841
Mailing Address - Fax:
Practice Address - Street 1:213 GARRISONWAY
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:MD
Practice Address - Zip Code:21826
Practice Address - Country:US
Practice Address - Phone:502-413-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121393163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health