Provider Demographics
NPI:1801064613
Name:BAUER, LORI LEIGH (RD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LEIGH
Last Name:BAUER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:LEIGH
Other - Last Name:MCLEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2521
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:916-965-4012
Mailing Address - Fax:916-965-1082
Practice Address - Street 1:4125 TEMESCAL
Practice Address - Street 2:STE J
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628
Practice Address - Country:US
Practice Address - Phone:916-965-4012
Practice Address - Fax:916-965-1082
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered