Provider Demographics
NPI:1720375710
Name:BAUMAN, SUSAN MARIE (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 HENSON AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1510
Mailing Address - Country:US
Mailing Address - Phone:269-492-6500
Mailing Address - Fax:269-492-6461
Practice Address - Street 1:1815 HENSON AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1510
Practice Address - Country:US
Practice Address - Phone:269-492-6500
Practice Address - Fax:269-492-6461
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704239157363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care