Provider Demographics
NPI:1205508041
Name:ANDREASON BAUER, GINA
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ANDREASON BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 GOODPASTURE LOOP APT 104
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-1621
Mailing Address - Country:US
Mailing Address - Phone:541-224-6606
Mailing Address - Fax:
Practice Address - Street 1:1 SERENITY LN
Practice Address - Street 2:
Practice Address - City:COBURG
Practice Address - State:OR
Practice Address - Zip Code:97408-9350
Practice Address - Country:US
Practice Address - Phone:541-262-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2024-07-03
Deactivation Date:2022-03-31
Deactivation Code:
Reactivation Date:2022-09-16
Provider Licenses
StateLicense IDTaxonomies
OR4414175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath