Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | R110105 | MD |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | R110105 | MD |
N | 363LP0200X | Nurse Practitioner - Pediatrics | SP018623 | PA |
NPI | 1124010004 |
---|---|
Provider Name | Jacquelyn P Bauer |
First Address | Cumberland, MD 21502-6844 |
Second Address | Cumberland, MD 21502-2755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 13/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0167161000 | (05) | WV |
103470021 | (05) | PA |
126751500 | (05) | MD |
S68246 | (02) |