Provider Demographics
NPI:1932404472
Name:BAUER, LANA R
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:R
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36779 240TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MCINTOSH
Mailing Address - State:MN
Mailing Address - Zip Code:56556-9258
Mailing Address - Country:US
Mailing Address - Phone:218-280-8384
Mailing Address - Fax:
Practice Address - Street 1:36779 240TH AVE SE
Practice Address - Street 2:
Practice Address - City:MCINTOSH
Practice Address - State:MN
Practice Address - Zip Code:56556-9258
Practice Address - Country:US
Practice Address - Phone:218-280-8384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver