Provider Demographics
NPI:1497058812
Name:BAUER, ANGELA MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:BAUER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:11143 PARKVIEW PLAZA DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1727
Mailing Address - Country:US
Mailing Address - Phone:260-482-3886
Mailing Address - Fax:260-482-1910
Practice Address - Street 1:11143 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 311
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1727
Practice Address - Country:US
Practice Address - Phone:260-482-3886
Practice Address - Fax:260-482-1910
Is Sole Proprietor?:No
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28147233A163W00000X
IN71003476A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse