Healthcare Provider Details

I. General information

NPI: 1306646252
Provider Name (Legal Business Name): AMBER JOY BAUER RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

V. Phone/Fax

Practice location:
  • Phone: 320-267-5196
  • Fax:
Mailing address:
  • Phone: 320-267-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number917535
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: