Provider Demographics
NPI:1336747641
Name:BAUERLE, JACQUELINE L (CPHT, CNA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:BAUERLE
Suffix:
Gender:F
Credentials:CPHT, CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 32ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-8604
Mailing Address - Country:US
Mailing Address - Phone:170-134-1747
Mailing Address - Fax:
Practice Address - Street 1:2650 32ND AVE NE APT 1
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-8604
Practice Address - Country:US
Practice Address - Phone:701-341-7476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16373OtherCERTIFIED NURSING ASSISTANT
ND1451384Medicaid
ND10014274OtherPHARMACY TECHNICIAN CERTIFICATION BOARD