Provider Demographics
NPI:1336235647
Name:BAKER, JANET L (RN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-3070
Mailing Address - Country:US
Mailing Address - Phone:217-345-9600
Mailing Address - Fax:217-345-3045
Practice Address - Street 1:25 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-3070
Practice Address - Country:US
Practice Address - Phone:217-345-9600
Practice Address - Fax:217-345-9600
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-004081163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK11731Medicare PIN
ILP71600Medicare UPIN