Provider Demographics
NPI:1639179641
Name:BAUER, TRUDY L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:TRUDY
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:L
Other - Last Name:KUNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:620 SPEAR ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363-1655
Mailing Address - Country:US
Mailing Address - Phone:610-932-9300
Mailing Address - Fax:610-932-5283
Practice Address - Street 1:620 SPEAR ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1655
Practice Address - Country:US
Practice Address - Phone:610-932-9300
Practice Address - Fax:610-932-5283
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006621B363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
047593GKGMedicare ID - Type Unspecified
P30851Medicare UPIN