Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R62114 | NM |
Y | 363LN0000X | Nurse Practitioner - Neonatal | R62114 | NM |
NPI | 1154503852 |
---|---|
Provider Name | Kathryn Bauer |
First Address | Albuquerque, NM 87131-0001 |
Second Address | Albuquerque, NM 87106-2745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2007 |
Last Update Date | 07/05/2012 |