Provider Demographics
NPI:1558039156
Name:BAUER, JENNIFER (LDN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HONEY BROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19344-1255
Mailing Address - Country:US
Mailing Address - Phone:267-246-0074
Mailing Address - Fax:
Practice Address - Street 1:31 HILLBROOK DR
Practice Address - Street 2:
Practice Address - City:HONEY BROOK
Practice Address - State:PA
Practice Address - Zip Code:19344-1255
Practice Address - Country:US
Practice Address - Phone:267-246-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007495133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education