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NPI Code Detail

MEDICARE: HEIDI BAUSCH B.A.

MEDICARE: HEIDI BAUSCH B.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1194195248
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI BAUSCH B.A.
Provider Business Mailing Address
First Line : 11505 36TH AVE N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2304
Country : US
Telephone Number : 763-509-3538
Fax Number :
Provider Business Practice Location Address
First Line : 11505 36TH AVE N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2304
Country : US
Telephone Number : 763-509-3538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2015
Last Update Date : 10/01/2015

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Directions to “ HEIDI BAUSCH B.A.” Practice Location

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