Provider Demographics
NPI:1720578602
Name:BAUER, STACIE L (RN)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2197 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14136-9762
Mailing Address - Country:US
Mailing Address - Phone:716-860-7465
Mailing Address - Fax:716-366-9355
Practice Address - Street 1:2197 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:SILVER CREEK
Practice Address - State:NY
Practice Address - Zip Code:14136-9762
Practice Address - Country:US
Practice Address - Phone:716-860-7465
Practice Address - Fax:716-366-9355
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY675949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse