Provider Demographics
NPI:1750926358
Name:BAUMAN, ANGELA G
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:G
Last Name:BAUMAN
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 1:1900 DENNIS FLAT RD.
Mailing Address - Street 2:
Mailing Address - City:DEETH
Mailing Address - State:NV
Mailing Address - Zip Code:89823
Mailing Address - Country:US
Mailing Address - Phone:775-752-3695
Mailing Address - Fax:
Practice Address - Street 1:3345 BRUCE DR
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-8663
Practice Address - Country:US
Practice Address - Phone:775-621-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician