Provider Demographics
NPI:1720842669
Name:BASKER, NINA ROSE (LM)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:ROSE
Last Name:BASKER
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1737
Mailing Address - Country:US
Mailing Address - Phone:415-858-8220
Mailing Address - Fax:
Practice Address - Street 1:39 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1737
Practice Address - Country:US
Practice Address - Phone:415-858-8220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA731176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife