Provider Demographics
NPI:1740386846
Name:BAUER, TERRI (RN, MSN, WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:RN, MSN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 1017
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-993-6401
Mailing Address - Fax:314-993-5475
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 1017
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-993-6401
Practice Address - Fax:314-993-5475
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN110562363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO920165457Medicaid
MO920165457Medicaid