Healthcare Provider Details

I. General information

NPI: 1720043573
Provider Name (Legal Business Name): STINA ADEL BAKER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 E GARFIELD AVE
MILWAUKEE WI
53212-3302
US

IV. Provider business mailing address

216 E GARFIELD AVE
MILWAUKEE WI
53212-3302
US

V. Phone/Fax

Practice location:
  • Phone: 414-562-2208
  • Fax:
Mailing address:
  • Phone: 414-562-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number28807-031
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: