Provider Demographics
NPI:1154138808
Name:BAKER, HALLIE (RN)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 JEFFERSON SCIO DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OR
Mailing Address - Zip Code:97352-9438
Mailing Address - Country:US
Mailing Address - Phone:503-508-8526
Mailing Address - Fax:
Practice Address - Street 1:304 JEFFERSON SCIO DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OR
Practice Address - Zip Code:97352-9438
Practice Address - Country:US
Practice Address - Phone:503-508-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10028484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse