Provider Demographics
NPI:1437155488
Name:BAUER, PATRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4337
Mailing Address - Country:US
Mailing Address - Phone:231-935-0799
Mailing Address - Fax:231-935-0962
Practice Address - Street 1:1719 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4337
Practice Address - Country:US
Practice Address - Phone:231-935-0799
Practice Address - Fax:231-935-0962
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704084045363LW0102X, 363LC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI234448194Medicaid
MI234448194Medicaid