Provider Demographics
NPI:1568873206
Name:BAKKER, MELISSA G (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:G
Last Name:BAKKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:G
Other - Last Name:HUNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9010 S PRIEST DR APT 2057
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1082
Mailing Address - Country:US
Mailing Address - Phone:404-441-2307
Mailing Address - Fax:
Practice Address - Street 1:16901 LAKESIDE HILLS CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:402-552-3022
Practice Address - Fax:402-552-3266
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225992367500000X
KS43-557677-121367500000X
NE101270367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered