Provider Demographics
NPI:1740678598
Name:KIMBERLEY BAUER NATUROPATHIC PHYSICIAN AND LICENSED MIDWIFE LLC
Entity type:Organization
Organization Name:KIMBERLEY BAUER NATUROPATHIC PHYSICIAN AND LICENSED MIDWIFE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:ND LM
Authorized Official - Phone:360-384-2900
Mailing Address - Street 1:2376 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-8605
Mailing Address - Country:US
Mailing Address - Phone:360-384-2900
Mailing Address - Fax:360-384-2955
Practice Address - Street 1:2376 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-8605
Practice Address - Country:US
Practice Address - Phone:360-384-2900
Practice Address - Fax:360-384-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60020654175F00000X
WAMIDW.MW.00000322176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty