Provider Demographics
NPI:1649063777
Name:BAKER, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BAKER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12010 LIVERPOOL RD
Mailing Address - Street 2:
Mailing Address - City:SANDYVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25275-6744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12010 LIVERPOOL RD
Practice Address - Street 2:
Practice Address - City:SANDYVILLE
Practice Address - State:WV
Practice Address - Zip Code:25275-6744
Practice Address - Country:US
Practice Address - Phone:304-532-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide