Provider Demographics
NPI:1265972384
Name:BAKER, JUSTINE MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:MARIE
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 1:29 KEMP DRIVE
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502
Mailing Address - Country:US
Mailing Address - Phone:585-465-3770
Mailing Address - Fax:
Practice Address - Street 1:29 KEMP DR
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8900
Practice Address - Country:US
Practice Address - Phone:585-465-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326850-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse