Provider Demographics
NPI:1376788638
Name:BAKKE, LAUREN E (MSN)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:E
Last Name:BAKKE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 ARNOLD DRIVE
Mailing Address - Street 2:19 MDOS/SGOKP
Mailing Address - City:LITTLE ROCK AFB
Mailing Address - State:AR
Mailing Address - Zip Code:72099-4933
Mailing Address - Country:US
Mailing Address - Phone:501-987-7493
Mailing Address - Fax:501-987-7424
Practice Address - Street 1:1090 ARNOLD DRIVE
Practice Address - Street 2:19 MDOS/SGOKP
Practice Address - City:LITTLE ROCK AFB
Practice Address - State:AR
Practice Address - Zip Code:72099-4933
Practice Address - Country:US
Practice Address - Phone:501-987-7493
Practice Address - Fax:501-987-7424
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056068-21163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory