Provider Demographics
NPI:1710782974
Name:BAKKER, JASE
Entity type:Individual
Prefix:
First Name:JASE
Middle Name:
Last Name:BAKKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 MONN AVE
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7168
Mailing Address - Country:US
Mailing Address - Phone:651-399-8629
Mailing Address - Fax:
Practice Address - Street 1:670 MONN AVE
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7168
Practice Address - Country:US
Practice Address - Phone:651-399-8629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program