Individual
KRISTIAN BAKKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 726-8854
(617) 724-9948
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 726-8854
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN262718
MA
363LA2100X
Acute Care Nurse Practitioner
Primary
RN262718
MA
363LG0600X
Gerontology Nurse Practitioner
RN262718
MA
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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