Healthcare Provider Details

I. General information

NPI: 1942752571
Provider Name (Legal Business Name): AMBER BAKKE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5037 43RD AVE S
MINNEAPOLIS MN
55417-1616
US

IV. Provider business mailing address

2104 NORTHDALE BLVD NW STE 220
COON RAPIDS MN
55433-3046
US

V. Phone/Fax

Practice location:
  • Phone: 651-334-0590
  • Fax:
Mailing address:
  • Phone: 763-537-6000
  • Fax: 763-537-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1973
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number111869
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: