MEDICARE: JOHN BAK CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	SP020925	PA
2	363L00000X	Nurse Practitioner	SP020925	PA

General Provider Information

NPI Number	:	1235770702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BAK CRNP

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-2695
Country	:	US
Telephone Number	:	570-271-6523
Fax Number	:	570-271-8056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2019
Last Update Date	:	02/03/2026

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