Healthcare Provider Details

I. General information

NPI: 1750340360
Provider Name (Legal Business Name): AMY BAKKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 7TH ST
OAKES ND
58474-2502
US

IV. Provider business mailing address

1200 N 7TH ST
OAKES ND
58474-2502
US

V. Phone/Fax

Practice location:
  • Phone: 701-742-2097
  • Fax:
Mailing address:
  • Phone: 701-742-3840
  • Fax: 651-735-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR34002
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR000775
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR34002
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCR-000775
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: