1548246226 NPI number — MRS. JANICE KAYE BAKER DO

Table of content: MRS. JANICE KAYE BAKER DO (NPI 1548246226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548246226 NPI number — MRS. JANICE KAYE BAKER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
JANICE
Provider Middle Name:
KAYE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TABB
Provider Other First Name:
JANICE
Provider Other Middle Name:
KAYE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548246226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2441
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52809-2441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-324-8160
Provider Business Mailing Address Fax Number:
563-324-8486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3705 UTICA RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETTENDORF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52722-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-324-8160
Provider Business Practice Location Address Fax Number:
563-324-8486
Provider Enumeration Date:
12/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  02219 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0043323 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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