Provider Demographics
NPI:1386340156
Name:BAKER, BONNIE WRAY
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:WRAY
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 1:1092 W WEBB LN
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-4504
Mailing Address - Country:US
Mailing Address - Phone:801-979-9325
Mailing Address - Fax:
Practice Address - Street 1:1092 W WEBB LN
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4504
Practice Address - Country:US
Practice Address - Phone:801-979-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT69Other69