Provider Demographics
NPI:1801951330
Name:BAIRD, HEATHER RUTH (NO CNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RUTH
Last Name:BAIRD
Suffix:
Gender:F
Credentials:NO CNP
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:RUTH
Other - Last Name:TRUITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NO CNP
Mailing Address - Street 1:7412 CRORY ROAD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406
Mailing Address - Country:US
Mailing Address - Phone:330-533-4848
Mailing Address - Fax:
Practice Address - Street 1:2249 ELM ROAD EXT
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410
Practice Address - Country:US
Practice Address - Phone:330-372-1608
Practice Address - Fax:330-372-1638
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH266491163W00000X
OH363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292899Medicaid
OH2292899Medicaid
OHBANP10621Medicare ID - Type Unspecified