Provider Demographics
NPI:1598497562
Name:BAK, EMILY ANN (RN)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:BAK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LAURETTA LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-1339
Mailing Address - Country:US
Mailing Address - Phone:401-286-9399
Mailing Address - Fax:
Practice Address - Street 1:3 LAURETTA LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1339
Practice Address - Country:US
Practice Address - Phone:401-286-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2333888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse