Provider Demographics
NPI:1801534300
Name:BAKER, ROBERT DOUGLAS (LPN, WCC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:BAKER
Suffix:
Gender:M
Credentials:LPN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 BLUESTEM DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7550
Mailing Address - Country:US
Mailing Address - Phone:513-520-3240
Mailing Address - Fax:
Practice Address - Street 1:11230 PIPPIN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1202
Practice Address - Country:US
Practice Address - Phone:513-851-0601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140621.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse