Provider Demographics
NPI:1083680557
Name:BAUER, BETH ANN (CRNA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:BAUER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:SMITH
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 READS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-1630
Mailing Address - Country:US
Mailing Address - Phone:302-709-4709
Mailing Address - Fax:302-709-4551
Practice Address - Street 1:200 BANNING STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904
Practice Address - Country:US
Practice Address - Phone:302-741-2272
Practice Address - Fax:302-741-2287
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0025956163W00000X
DEL6-0A00369367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
55027OtherAANA
DE10000356637Medicaid
55027OtherAANA
DE010779Medicare PIN