Provider Demographics
NPI:1609819853
Name:BAUMAN, JEFFERY WARREN (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:WARREN
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-8621
Mailing Address - Country:US
Mailing Address - Phone:256-757-0814
Mailing Address - Fax:
Practice Address - Street 1:205 MARENGO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6033
Practice Address - Country:US
Practice Address - Phone:256-768-9191
Practice Address - Fax:256-768-9775
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-063474367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S62069Medicare UPIN