Provider Demographics
NPI:1831388859
Name:BAUER, LAURA SUDBURY (MHS, PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:SUDBURY
Last Name:BAUER
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:SUDBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 COOL SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2677
Mailing Address - Country:US
Mailing Address - Phone:615-771-7546
Mailing Address - Fax:615-771-8600
Practice Address - Street 1:200 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2677
Practice Address - Country:US
Practice Address - Phone:615-771-7546
Practice Address - Fax:615-771-8600
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1779363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I976777Medicare PIN