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NPI Code Detail

MEDICARE: MARY LAUREN BAUER CRNA

MEDICARE: MARY LAUREN BAUER CRNA
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 ProgramIN

General Provider Information

NPI Number : 1912834904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LAUREN BAUER CRNA
Provider Business Mailing Address
First Line : PO BOX 843603
Second Line :
City : DALLAS
State : TX
Zip : 75284-3603
Country : US
Telephone Number : 407-667-0444
Fax Number : 407-667-4338
Provider Business Practice Location Address
First Line : 6435 W JEFFERSON BLVD # 434
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-6203
Country : US
Telephone Number : 260-436-7875
Fax Number : 260-432-9812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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Directions to “ MARY LAUREN BAUER CRNA” Practice Location

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