Provider Demographics
NPI:1306382312
Name:BAKER, ALYSSA (RN BSN)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11261 E 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:CO
Mailing Address - Zip Code:80640-7658
Mailing Address - Country:US
Mailing Address - Phone:720-438-1093
Mailing Address - Fax:
Practice Address - Street 1:11261 E 114TH AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:CO
Practice Address - Zip Code:80640-7658
Practice Address - Country:US
Practice Address - Phone:720-438-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0193085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse