Provider Demographics
NPI:1356880413
Name:BAKKE, DANA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:BAKKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:SNUGGERUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:920 EAST 28TH STREET
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407
Mailing Address - Country:US
Mailing Address - Phone:612-863-7770
Mailing Address - Fax:612-863-7772
Practice Address - Street 1:920 EAST 28TH STREET
Practice Address - Street 2:SUITE 460
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407
Practice Address - Country:US
Practice Address - Phone:612-863-7770
Practice Address - Fax:612-863-7772
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MN12366363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant