Provider Demographics
NPI:1831378025
Name:BLAKER ENTERPRISES INC
Entity type:Organization
Organization Name:BLAKER ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLAKER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:541-284-8882
Mailing Address - Street 1:1902 JEFFERSON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2414
Mailing Address - Country:US
Mailing Address - Phone:541-284-8882
Mailing Address - Fax:541-284-2826
Practice Address - Street 1:1902 JEFFERSON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2414
Practice Address - Country:US
Practice Address - Phone:541-284-8882
Practice Address - Fax:541-284-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2017-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR90006820N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119347Medicare PIN