Provider Demographics
NPI:1700184306
Name:BAUER, ANGIE DIANE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:DIANE
Last Name:BAUER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 GLENEAGLES PL
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7517
Mailing Address - Country:US
Mailing Address - Phone:812-584-5928
Mailing Address - Fax:
Practice Address - Street 1:107 BRIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1378
Practice Address - Country:US
Practice Address - Phone:812-926-0744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-05
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 12215 NP363LF0000X
KY3007964363LF0000X
IN71010554A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100290260Medicaid
OH0053056Medicaid
IN201222370Medicaid
OHH023151Medicare PIN