Provider Demographics
NPI:1811282213
Name:BAUER, SHANDRA ANN (PA)
Entity type:Individual
Prefix:
First Name:SHANDRA
Middle Name:ANN
Last Name:BAUER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6242 SANDSNES LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4851
Mailing Address - Country:US
Mailing Address - Phone:414-339-3212
Mailing Address - Fax:
Practice Address - Street 1:451 JUNCTION RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2656
Practice Address - Country:US
Practice Address - Phone:608-829-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical