Provider Demographics
NPI:1497124945
Name:BAUMAN, KRYSTAL (CNS)
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 FOX HAVEN CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4008
Mailing Address - Country:US
Mailing Address - Phone:757-254-7161
Mailing Address - Fax:
Practice Address - Street 1:6008 FOX HAVEN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4008
Practice Address - Country:US
Practice Address - Phone:757-254-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237218163WM0705X
IL041.367227163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical