Provider Demographics
NPI:1639285968
Name:BAUER, STEPHANIE LEE (FNP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LEE
Last Name:BAUER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-8304
Mailing Address - Fax:314-454-5902
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV IM BONE MARROW TRANSPLANT, 7TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-454-8304
Practice Address - Fax:314-454-5902
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO143939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425709300Medicaid
IL$$$$$$$$$001Medicaid
MO826240183Medicare PIN
MO500023913Medicare PIN