Provider Demographics
NPI:1790865673
Name:BAKKEN, JOANNE A (FNP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:A
Last Name:BAKKEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 MAIN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4233
Mailing Address - Country:US
Mailing Address - Phone:701-572-7711
Mailing Address - Fax:701-572-2283
Practice Address - Street 1:1102 MAIN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4233
Practice Address - Country:US
Practice Address - Phone:701-572-7711
Practice Address - Fax:701-572-2283
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25271363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19570Medicaid
S33878Medicare UPIN
ND14629Medicare ID - Type Unspecified
ND19570Medicaid