Provider Demographics
NPI:1548527682
Name:BAKER, SHEILA (CHA III)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CHA III
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:545 TUNDRA STREET
Mailing Address - Street 2:
Mailing Address - City:TELLER
Mailing Address - State:AK
Mailing Address - Zip Code:99778
Mailing Address - Country:US
Mailing Address - Phone:907-642-3311
Mailing Address - Fax:907-642-2046
Practice Address - Street 1:545 TUNDRA STREET
Practice Address - Street 2:
Practice Address - City:TELLER
Practice Address - State:AK
Practice Address - Zip Code:99778
Practice Address - Country:US
Practice Address - Phone:907-642-3311
Practice Address - Fax:907-642-2046
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK12-1177-III172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK12-1177-IIIOtherCHA III