Basic Information
| Provider Information | |||||||||
| NPI: | 1508460122 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKKEN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | CDCES | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5225 23RD AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581047927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014172540 | ||||||||
| FaxNumber: | 7014172535 | ||||||||
| Practice Location | |||||||||
| Address1: | 5225 23RD AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581047927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014172540 | ||||||||
| FaxNumber: | 7014172535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2020 | ||||||||
| LastUpdateDate: | 11/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 22200248 | ND | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.