Provider Demographics
NPI:1912778291
Name:BAKKER, JANINA ROSE
Entity Type:Individual
Prefix:
First Name:JANINA
Middle Name:ROSE
Last Name:BAKKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANINA
Other - Middle Name:ROSE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1315 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-1913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:930 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333-2254
Practice Address - Country:US
Practice Address - Phone:402-826-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19227146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic