Provider Demographics
NPI:1376142075
Name:BAUER, JULIE DANETTE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:DANETTE
Last Name:BAUER
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 1:76 WEIR DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ND
Mailing Address - Zip Code:58504-9199
Mailing Address - Country:US
Mailing Address - Phone:701-426-2567
Mailing Address - Fax:
Practice Address - Street 1:76 WEIR DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ND
Practice Address - Zip Code:58504-9199
Practice Address - Country:US
Practice Address - Phone:701-426-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDBAU5993953747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant