Provider Demographics
NPI:1881105740
Name:BAUER, THOMAS E (CNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:BAUER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 FAWLEY LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45148-9506
Mailing Address - Country:US
Mailing Address - Phone:513-601-5757
Mailing Address - Fax:
Practice Address - Street 1:6722 STATE ROUTE 132
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9249
Practice Address - Country:US
Practice Address - Phone:513-575-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021709363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily