Provider Demographics
NPI:1265883557
Name:BAUER, JESSICA (NPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5630
Mailing Address - Country:US
Mailing Address - Phone:336-222-8888
Mailing Address - Fax:336-222-0549
Practice Address - Street 1:1713 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5630
Practice Address - Country:US
Practice Address - Phone:336-222-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCNP.019303363LF0000X
NC5011504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5011504OtherNORTH CAROLINA BOARD OF NURSING
OHCNP.019303OtherOHIO BOARD OF NURSING