Provider Demographics
NPI:1831393487
Name:BAKER, NICOLE LYNN (RRT RCP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LYNN
Last Name:BAKER
Suffix:
Gender:F
Credentials:RRT RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 LAWNDALE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3030
Mailing Address - Country:US
Mailing Address - Phone:336-558-5092
Mailing Address - Fax:
Practice Address - Street 1:206 LAWNDALE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3030
Practice Address - Country:US
Practice Address - Phone:336-558-5092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA32172279C0205X
IL2279C0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredCritical Care