Healthcare Provider Details

I. General information

NPI: 1073153003
Provider Name (Legal Business Name): DANIELLE BENTRUP BAKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W MAPLE AVE
SPRINGDALE AR
72764-5335
US

IV. Provider business mailing address

14700 MEADOWLAND CIR
NEWARK TX
76071-8905
US

V. Phone/Fax

Practice location:
  • Phone: 479-751-5711
  • Fax: 479-751-1099
Mailing address:
  • Phone: 318-564-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number918052
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number230551
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1001195
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11020306
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number221343
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: