MEDICARE: DIAN ADELLE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1710562384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIAN ADELLE BAKER

Provider Business Mailing Address
First Line	:	53480 YORK DR
Second Line	:
City	:	POWHATAN POINT
State	:	OH
Zip	:	43942-9752
Country	:	US
Telephone Number	:	740-310-2935
Fax Number	:

Provider Business Practice Location Address
First Line	:	53480 YORK DR
Second Line	:
City	:	POWHATAN POINT
State	:	OH
Zip	:	43942-9752
Country	:	US
Telephone Number	:	740-310-2935
Fax Number	:

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

Provider Enumeration Date	:	03/15/2021
Last Update Date	:	03/15/2021

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Directions to “ DIAN ADELLE BAKER ” Practice Location

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