Provider Demographics
NPI:1750340360
Name:BAKKE, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BAKKE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-2502
Mailing Address - Country:US
Mailing Address - Phone:701-742-3840
Mailing Address - Fax:651-735-1870
Practice Address - Street 1:1200 N 7TH ST
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-2502
Practice Address - Country:US
Practice Address - Phone:701-742-2097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR34002363L00000X, 367500000X, 363L00000X
SDCR-000775367500000X
MNCR000775367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44350000Medicaid
ND1450745Medicaid