Basic Information
| Provider Information | |||||||||
| NPI: | 1386630820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER-HALL | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 W STEVENS AVE | ||||||||
| Address2: | |||||||||
| City: | SULTAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982949458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607930201 | ||||||||
| FaxNumber: | 3607932429 | ||||||||
| Practice Location | |||||||||
| Address1: | 615 W STEVENS AVE | ||||||||
| Address2: | |||||||||
| City: | SULTAN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982949458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607930201 | ||||||||
| FaxNumber: | 3607932429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 01/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00024221 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8304438 | 05 | WA | MEDICAID |