Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 110714 | NE |
NPI | 1053301317 |
---|---|
Provider Name | Amanda Dawn Bauer |
First Address | Lincoln, NE 68510-2496 |
Second Address | Lincoln, NE 68510-2496 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1603354 | UHC (01) | NE |
248565 | MIDLANDS CHOICE (01) | NE |
37685 | BCBS (01) | NE |
91186278513 | (05) | NE |
Q48081 | (02) |