Individual
MRS. SALLY JO BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2900 FIRST AVENUE, HUNTINGTON, WV 25702-1241
(304) 526-1031
Mailing address
PO BOX 515, BARBOURSVILLE, WV 25504-0515
(304) 736-6126
(304) 736-1531
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
04994
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
43588
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001710226
W.V. BLUE CROSS PROVIDER
WV
05
—
0068000000
—
WV
01
—
55-0696369-00
WV WORKERS COMP #
WV
Enumeration date
11/14/2006
Last updated
09/23/2011
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