Healthcare Provider Details

I. General information

NPI: 1780305243
Provider Name (Legal Business Name): MISS SYDNEY CAROL BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BOULDER FALLS DR APT 117
LEBANON OR
97355-2881
US

IV. Provider business mailing address

286 PARK ST
LEBANON OR
97355-4226
US

V. Phone/Fax

Practice location:
  • Phone: 541-405-2049
  • Fax:
Mailing address:
  • Phone: 503-328-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: