Provider Demographics
NPI:1487217931
Name:BAKER, JASON JOHN (AGANCP-BC, CCRN, RN)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:JOHN
Last Name:BAKER
Suffix:
Gender:M
Credentials:AGANCP-BC, CCRN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 LEBLANC ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3912
Mailing Address - Country:US
Mailing Address - Phone:313-402-9257
Mailing Address - Fax:
Practice Address - Street 1:18000 W 9 MILE RD STE 525
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4080
Practice Address - Country:US
Practice Address - Phone:248-327-6196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704272464363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care