Provider Demographics
NPI:1235349218
Name:BAUMAN, BETTY L (LPN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3479 BLAKELEY AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7553
Mailing Address - Country:US
Mailing Address - Phone:715-492-0163
Mailing Address - Fax:
Practice Address - Street 1:3479 BLAKELEY AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7553
Practice Address - Country:US
Practice Address - Phone:715-492-0163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34708-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38322600Medicaid