Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD197959 | OR |
Y | 2080P0210X | Pediatric Nephrologist | MD197959 | OR |
NPI | 1952644817 |
---|---|
Provider Name | Abbie Ruth Bauer |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2013 |
Last Update Date | 28/09/2020 |