Provider Demographics
NPI:1689061236
Name:BAUER, CATRINA LYNN
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:LYNN
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 1:7300 NE VANCOUVER MALL DR
Mailing Address - Street 2:APT. H-77
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6749
Mailing Address - Country:US
Mailing Address - Phone:602-469-6669
Mailing Address - Fax:
Practice Address - Street 1:1419 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-9830
Practice Address - Country:US
Practice Address - Phone:360-666-7755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60138887171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor