Provider Demographics
NPI:1720299209
Name:BAKER, VIRGINIA MARTHA (RN, IBCLC-R)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:MARTHA
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN, IBCLC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22027 N PARADA DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-2896
Mailing Address - Country:US
Mailing Address - Phone:619-253-4854
Mailing Address - Fax:
Practice Address - Street 1:22027 N PARADA DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-2896
Practice Address - Country:US
Practice Address - Phone:619-253-4854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280407163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant