Provider Demographics
NPI:1275919649
Name:BAUTERS, ISABELLA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:BAUTERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 BOSTON POST RD STE 4C
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3022
Mailing Address - Country:US
Mailing Address - Phone:978-443-6960
Mailing Address - Fax:978-443-6502
Practice Address - Street 1:323 BOSTON POST RD STE 4C
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3022
Practice Address - Country:US
Practice Address - Phone:978-443-6960
Practice Address - Fax:978-443-6502
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-07
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2292098163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse