Provider Demographics
NPI:1013343508
Name:BAUER, NANCY J (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:BAUER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:MEOMARTINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 BLUEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01756-1378
Mailing Address - Country:US
Mailing Address - Phone:508-478-4488
Mailing Address - Fax:
Practice Address - Street 1:3 BLUEBERRY DR
Practice Address - Street 2:
Practice Address - City:MENDON
Practice Address - State:MA
Practice Address - Zip Code:01756-1378
Practice Address - Country:US
Practice Address - Phone:508-478-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262850163W00000X
RIRN47641163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse