Healthcare Provider Details

I. General information

NPI: 1114832805
Provider Name (Legal Business Name): JORDAN LYNN BAUER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 NEBRASKA ST
SIOUX CITY IA
51105-1436
US

IV. Provider business mailing address

1021 NEBRASKA ST
SIOUX CITY IA
51105-1436
US

V. Phone/Fax

Practice location:
  • Phone: 712-252-2477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA193479
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: