Provider Demographics
NPI:1871257659
Name:BAUER, CAITLYN ANN (RDN)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:ANN
Last Name:BAUER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:ANN
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:7118 THAMESFORD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-1887
Mailing Address - Country:US
Mailing Address - Phone:765-546-9034
Mailing Address - Fax:
Practice Address - Street 1:401 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2568
Practice Address - Country:US
Practice Address - Phone:260-347-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1083287133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered