Healthcare Provider Details

I. General information

NPI: 1912834904
Provider Name (Legal Business Name): MARY LAUREN BAUER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY MUSKAT

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 W JEFFERSON BLVD # 434
FORT WAYNE IN
46804-6203
US

IV. Provider business mailing address

PO BOX 843603
DALLAS TX
75284-3603
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-7875
  • Fax: 260-432-9812
Mailing address:
  • Phone: 407-667-0444
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: