MEDICARE: MRS. MELISSA G BAKKER DNP

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	367500000X	Certified Registered Nurse Anesthetist	28301482	IN
2	367500000X	Certified Registered Nurse Anesthetist	101270	NE
3	367500000X	Certified Registered Nurse Anesthetist	4038604	KY
4	367500000X	Certified Registered Nurse Anesthetist	225992	AZ
5	367500000X	Certified Registered Nurse Anesthetist	209-026749	IL
6	367500000X	Certified Registered Nurse Anesthetist	43-557677-121	KS
7	367500000X	Certified Registered Nurse Anesthetist	26968	TN

General Provider Information

NPI Number	:	1568873206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA G BAKKER DNP

Provider Business Mailing Address
First Line	:	904 DILLON GRIBBLE RD
Second Line	:
City	:	SPARTA
State	:	TN
Zip	:	38583-6420
Country	:	US
Telephone Number	:	404-441-2307
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 JOHN DEERE RD
Second Line	:
City	:	MOLINE
State	:	IL
Zip	:	61265-6892
Country	:	US
Telephone Number	:	308-779-5000
Fax Number	:

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

Provider Enumeration Date	:	05/15/2014
Last Update Date	:	04/15/2026

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