MEDICARE: MRS. DONNA MECHELLE BAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	347C00000X	Private Vehicle	1406247864	NV
2	343900000X	Non-emergency Medical Transport (VAN)	1406247864	NV

General Provider Information

NPI Number	:	1205602869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA MECHELLE BAKER

Provider Business Mailing Address
First Line	:	6960 N 5TH ST # 1203
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1351
Country	:	US
Telephone Number	:	720-376-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	5720 ALITAK BAY ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6816
Country	:	US
Telephone Number	:	720-376-1975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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