Healthcare Provider Details

I. General information

NPI: 1720299209
Provider Name (Legal Business Name): VIRGINIA MARTHA BAKER RN, IBCLC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22027 N PARADA DR
SUN CITY WEST AZ
85375-2896
US

IV. Provider business mailing address

22027 N PARADA DR
SUN CITY WEST AZ
85375-2896
US

V. Phone/Fax

Practice location:
  • Phone: 619-253-4854
  • Fax:
Mailing address:
  • Phone: 619-253-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number280407
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: