Provider Demographics
NPI:1003904061
Name:BAUER, JODY L (ARNP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:L
Other - Last Name:HOPPIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3111 WOBURN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6610
Mailing Address - Country:US
Mailing Address - Phone:360-734-1420
Mailing Address - Fax:360-733-1659
Practice Address - Street 1:3111 WOBURN ST STE 201
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6610
Practice Address - Country:US
Practice Address - Phone:360-734-1420
Practice Address - Fax:360-733-1659
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARN00114758OtherLICENSE
WA3022HOOtherREGENCE BLUE SHIELD
WAAP30004830OtherLICENSE