Individual
CARLY JEAN BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 N COURT ST, SPARTA, WI 54656-1708
(608) 633-3333
Mailing address
146 TILSON ST E, WEST SALEM, WI 54669-1213
(608) 792-2646
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
302971-031
WI
Other
Enumeration date
08/23/2010
Last updated
08/23/2010
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