Provider Demographics
NPI:1801066139
Name:BAUMANN, ANDREA SUE (RD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUE
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:SUE
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2660 NE HIGHWAY 20 STE 610-26
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6402
Mailing Address - Country:US
Mailing Address - Phone:360-265-4754
Mailing Address - Fax:541-385-4987
Practice Address - Street 1:384 SW UPPER TERRACE DR STE 213
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3514
Practice Address - Country:US
Practice Address - Phone:360-265-4754
Practice Address - Fax:541-385-4987
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-000708133V00000X
OR708133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500665841Medicaid
ORR140849Medicare PIN