Provider Demographics
NPI:1396088241
Name:BACA, CORTNEY LYN
Entity type:Individual
Prefix:MRS
First Name:CORTNEY
Middle Name:LYN
Last Name:BACA
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 1:1048 PARKSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-3212
Mailing Address - Country:US
Mailing Address - Phone:575-636-5739
Mailing Address - Fax:
Practice Address - Street 1:1048 PARKSLEY AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-3212
Practice Address - Country:US
Practice Address - Phone:575-636-5739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula