Provider Demographics
NPI:1073153003
Name:BAKER, DANIELLE BENTRUP (CRNA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:BENTRUP
Last Name:BAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 MEADOWLAND CIR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:TX
Mailing Address - Zip Code:76071-8905
Mailing Address - Country:US
Mailing Address - Phone:318-564-7888
Mailing Address - Fax:
Practice Address - Street 1:609 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5335
Practice Address - Country:US
Practice Address - Phone:479-751-5711
Practice Address - Fax:479-751-1099
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX918052163WS0200X
LA230551367500000X
TX1001195367500000X
FLAPRN11020306367500000X
AR221343367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WS0200XNursing Service ProvidersRegistered NurseSchool