Individual
MS. SELENA LAUREN BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 838-7493
Mailing address
1808 PERRINE ST, LAFAYETTE, IN 47904-1446
(765) 337-2093
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
37003070A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37003070A
INDIANA PROFESSIONAL LICENSING AGENCY MEDICAL LICENSING BOARD OF INDIANA
IN
01
—
984074
COMMISSION ON DIETETIC REGISTRATION
—
Enumeration date
03/10/2021
Last updated
03/10/2021
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