Provider Demographics
NPI:1629304092
Name:BAUER, MELANIE JO
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:JO
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E DOWLING RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1918
Mailing Address - Country:US
Mailing Address - Phone:907-569-7135
Mailing Address - Fax:907-868-4658
Practice Address - Street 1:1801 E DOWLING RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1918
Practice Address - Country:US
Practice Address - Phone:907-569-7135
Practice Address - Fax:907-868-4658
Is Sole Proprietor?:No
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG107Medicaid