Provider Demographics
NPI:1093601189
Name:BAWIDAMANN, MANDI L
Entity type:Individual
Prefix:
First Name:MANDI
Middle Name:L
Last Name:BAWIDAMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8981 ST RT 380
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-9035
Mailing Address - Country:US
Mailing Address - Phone:937-728-1591
Mailing Address - Fax:
Practice Address - Street 1:8981 ST RT 380
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-9035
Practice Address - Country:US
Practice Address - Phone:937-728-1591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver