Provider Demographics
NPI:1467880401
Name:BAUCH, MARIE LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LYNN
Last Name:BAUCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:LYNN
Other - Last Name:SAMPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2104
Mailing Address - Country:US
Mailing Address - Phone:678-416-3568
Mailing Address - Fax:
Practice Address - Street 1:14557 HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-9582
Practice Address - Country:US
Practice Address - Phone:678-688-1580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-30
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily