Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 4704084045 | MI |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704084045 | MI |
N | 363LW0102X | Nurse Practitioner - Women's Health | 4704084045 | MI |
NPI | 1437155488 |
---|---|
Provider Name | Patricia Bauer |
First Address | Traverse City, MI 49686-4337 |
Second Address | Traverse City, MI 49686-4337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 07/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
234448194 | (05) | MI |