| Doctor Name: | MANISA BAKER |
| NPI Number: | 1023479508 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 209006813 |
| Business Practice Address: | 3815 Highland Ave Downers Grove, IL - 605151500 |
| Business Phone Number: | 6302755900 |
| Business Fax Number: | |
| Mailing Address: | 8167 Magoun Dr, SAINT JOHN |
| State: | IN |
| Postal Code: | 463738888 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/11/2016 |
| NPI Last Update Date: | 03/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SA2100X |
| License Number: | 209006813 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |