Provider Demographics
NPI:1043259070
Name:FERRERA BAUMANN, ANNA ELIZABETH NICOLA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:ELIZABETH NICOLA
Last Name:FERRERA BAUMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:WANYIK-FERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:880 ALDER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89451-8335
Mailing Address - Country:US
Mailing Address - Phone:775-831-6200
Mailing Address - Fax:775-888-4239
Practice Address - Street 1:880 ALDER AVE FL 2
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-8335
Practice Address - Country:US
Practice Address - Phone:775-831-6200
Practice Address - Fax:775-888-4239
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11174425OtherCAQH
NV1043259070Medicaid
NVV105368Medicare PIN
11174425OtherCAQH