Provider Demographics
NPI:1952881708
Name:BAKER, EVERDNA L (LPN)
Entity Type:Individual
Prefix:
First Name:EVERDNA
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5652 MAGNOLIA RUN CIR APT 107
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-1681
Mailing Address - Country:US
Mailing Address - Phone:757-790-1851
Mailing Address - Fax:
Practice Address - Street 1:5652 MAGNOLIA RUN CIR APT 107
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-1681
Practice Address - Country:US
Practice Address - Phone:757-790-1851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002097195364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health