Provider Demographics
NPI:1932781044
Name:BAUER, AMANDA (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 S SAGINAW ST STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2434
Mailing Address - Country:US
Mailing Address - Phone:810-377-6850
Mailing Address - Fax:
Practice Address - Street 1:8203 S SAGINAW ST STE C
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2434
Practice Address - Country:US
Practice Address - Phone:810-432-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704390428363LP0200X
CA95018520363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics