Provider Demographics
NPI:1952598427
Name:BAUER, JEANNETTE ARLENE (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:ARLENE
Last Name:BAUER
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:MISS
Other - First Name:JEANNETTE
Other - Middle Name:ARLENE
Other - Last Name:BERGLUND, NOBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:36 KLONDIKE RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9701
Mailing Address - Country:US
Mailing Address - Phone:509-775-3333
Mailing Address - Fax:
Practice Address - Street 1:36 KLONDIKE RD
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-9701
Practice Address - Country:US
Practice Address - Phone:509-775-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60735449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9972222Medicaid
MTPTAN011002272Medicare UPIN