Healthcare Provider Details

I. General information

NPI: 1326885781
Provider Name (Legal Business Name): LIA MARIE BAHLS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR STE 202
SANTA ROSA CA
95403-1671
US

IV. Provider business mailing address

3883 AIRWAY DR STE 202
SANTA ROSA CA
95403-1671
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7777
  • Fax:
Mailing address:
  • Phone: 707-521-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNPF95038938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: