Provider Demographics
NPI:1720841695
Name:BAUER, TRACY ELLEN
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ELLEN
Last Name: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 1:9 LITTLE TARN CT
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-1262
Mailing Address - Country:US
Mailing Address - Phone:973-756-6109
Mailing Address - Fax:
Practice Address - Street 1:9 LITTLE TARN CT
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NJ
Practice Address - Zip Code:07419-1262
Practice Address - Country:US
Practice Address - Phone:973-756-6109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program