Provider Demographics
NPI:1568634202
Name:BAUER, KIMBERLEY A (ND LM)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:A
Last Name:BAUER
Suffix:
Gender:F
Credentials:ND LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2376 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8605
Mailing Address - Country:US
Mailing Address - Phone:360-384-2900
Mailing Address - Fax:360-384-2955
Practice Address - Street 1:2376 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8605
Practice Address - Country:US
Practice Address - Phone:360-384-2900
Practice Address - Fax:360-384-2955
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMIDW.MW.00000322176B00000X
WANT60020654175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No176B00000XOther Service ProvidersMidwife