Provider Demographics
NPI:1346231412
Name:BAUER, JENNIFER S (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:BAUER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:621 MEMORIAL DR STE 302
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1073
Practice Address - Country:US
Practice Address - Phone:574-367-3800
Practice Address - Fax:574-367-3801
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001701A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300014674Medicaid
IN000000510915OtherANTHEM BCBS
IN000000721414OtherBCBS MEMORIAL BARIATRIC
IN200482190Medicaid
IN000000678796OtherBCBS MED POINT ERSKINE
IN200482190Medicaid
INM400033943Medicare PIN
INM400052781Medicare PIN
IN000000721414OtherBCBS MEMORIAL BARIATRIC
IN224040CMedicare PIN