Provider Demographics
NPI:1386132033
Name:BAKER, SHELLY-ANNE MARIE (RN)
Entity type:Individual
Prefix:
First Name:SHELLY-ANNE
Middle Name:MARIE
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 1:4065 N ALASKA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2001
Mailing Address - Country:US
Mailing Address - Phone:214-415-7743
Mailing Address - Fax:
Practice Address - Street 1:4065 N ALASKA ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-2001
Practice Address - Country:US
Practice Address - Phone:214-415-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201705501RN163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator