Provider Demographics
NPI:1992959670
Name:BAKKER, YVONNE MONIQUE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:MONIQUE
Last Name:BAKKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 121ST ST E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-3035
Mailing Address - Country:US
Mailing Address - Phone:253-617-3502
Mailing Address - Fax:
Practice Address - Street 1:921 121ST ST E
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98445-3035
Practice Address - Country:US
Practice Address - Phone:253-617-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60041191122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist