Provider Demographics
NPI:1427006337
Name:BAUER, MARY C (RN, MSN, APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:BAUER
Suffix:
Gender:F
Credentials:RN, MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 WYNFIELD TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129
Mailing Address - Country:US
Mailing Address - Phone:314-518-2837
Mailing Address - Fax:
Practice Address - Street 1:225 S MERAMEC AVE STE 409
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3511
Practice Address - Country:US
Practice Address - Phone:314-556-0009
Practice Address - Fax:314-492-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO069486363LA2200X
MO2012032346363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health