Provider Demographics
NPI:1053485953
Name:BAKKEN, LYNN B (C-PNP)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:B
Last Name:BAKKEN
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3611
Mailing Address - Country:US
Mailing Address - Phone:303-238-4662
Mailing Address - Fax:303-467-5355
Practice Address - Street 1:80 S TELLER ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2044
Practice Address - Country:US
Practice Address - Phone:303-238-4662
Practice Address - Fax:303-238-8796
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0124192163W00000X
COAPN.0003000-NP363LP0200X
CORXN.0000161-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner