Provider Demographics
NPI:1295280774
Name:BAKER, DEBRA MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:BAKER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARIE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:734 N 1ST ST
Mailing Address - Street 2:734 N FIRST ST
Mailing Address - City:ELBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60119-8913
Mailing Address - Country:US
Mailing Address - Phone:630-899-9041
Mailing Address - Fax:630-420-6471
Practice Address - Street 1:500 WARWICK DR
Practice Address - Street 2:500WARWICK
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2603
Practice Address - Country:US
Practice Address - Phone:630-637-4031
Practice Address - Fax:630-420-6471
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.171440163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse