Provider Demographics
NPI:1962985515
Name:BAKER, TERRIE D (LVN)
Entity type:Individual
Prefix:MS
First Name:TERRIE
Middle Name:D
Last Name:BAKER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 FM 1092 RD APT 1208
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1608
Mailing Address - Country:US
Mailing Address - Phone:409-998-9857
Mailing Address - Fax:
Practice Address - Street 1:1800 FM 1092 RD APT 1208
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1608
Practice Address - Country:US
Practice Address - Phone:409-998-9857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194380164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse