Provider Demographics
NPI:1114906120
Name:BAUMAN, SUSAN F (RN NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:RN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1230 E MAIN ST
Mailing Address - Street 2:PO BOX 8674
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5066
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:507-625-1878
Practice Address - Street 1:1230 E MAIN ST
Practice Address - Street 2:MANKATO CLINIC AT MAIN STREET
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5066
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:507-625-1878
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR0743451363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN599214100Medicaid
MNNA2951023871OtherPREFERRED ONE
MN03A64BAOtherBCBS
500004161OtherRR MEDICARE
41084933956001C158OtherCHAMPUS
IA938480Medicaid
MN0401492OtherMEDICA
MN124709OtherUCARE
MNHP40993OtherHEALTH PARTNERS
MNNA2951023871OtherPREFERRED ONE
MNHP40993OtherHEALTH PARTNERS