Healthcare Provider Details

I. General information

NPI: 1861457194
Provider Name (Legal Business Name): SUSAN J BAUER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 EISENHOWER AVE GREAT BEND CHILDREN'S CLINIC
GREAT BEND KS
67530-3213
US

IV. Provider business mailing address

1021 EISENHOWER AVE GREAT BEND CHILDREN'S CLINIC
GREAT BEND KS
67530-3213
US

V. Phone/Fax

Practice location:
  • Phone: 620-792-5848
  • Fax:
Mailing address:
  • Phone: 620-792-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number44343
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: