Provider Demographics
NPI:1336613306
Name:BAKER, SUZANNE R
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 TWIN BUTTE RD
Mailing Address - Street 2:
Mailing Address - City:MENAN
Mailing Address - State:ID
Mailing Address - Zip Code:83434-5117
Mailing Address - Country:US
Mailing Address - Phone:208-360-0276
Mailing Address - Fax:
Practice Address - Street 1:1190 TWIN BUTTE RD
Practice Address - Street 2:
Practice Address - City:MENAN
Practice Address - State:ID
Practice Address - Zip Code:83434-5117
Practice Address - Country:US
Practice Address - Phone:208-360-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)