Provider Demographics
NPI:1194232587
Name:BAKER, JALON NICOLE
Entity type:Individual
Prefix:
First Name:JALON
Middle Name:NICOLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 COACHMAN DR APT 3
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1539
Mailing Address - Country:US
Mailing Address - Phone:248-657-0701
Mailing Address - Fax:
Practice Address - Street 1:743 COACHMAN DR APT 3
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1539
Practice Address - Country:US
Practice Address - Phone:248-657-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-07
Last Update Date:2018-01-18
Deactivation Date:2018-01-08
Deactivation Code:
Reactivation Date:2018-01-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other