Provider Demographics
NPI:1538818836
Name:BAKER, HAVALA HOLMES
Entity type:Individual
Prefix:
First Name:HAVALA
Middle Name:HOLMES
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HAVALA
Other - Middle Name:MEGAN
Other - Last Name:HOLMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2309 SULLIVAN DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7744
Mailing Address - Country:US
Mailing Address - Phone:360-620-8282
Mailing Address - Fax:
Practice Address - Street 1:2309 SULLIVAN DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7744
Practice Address - Country:US
Practice Address - Phone:360-620-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator