Healthcare Provider Details

I. General information

NPI: 1003229204
Provider Name (Legal Business Name): NAOMI NOELLE BACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 6TH AVE
WORTHINGTON MN
56187-2202
US

IV. Provider business mailing address

1018 6TH AVE PO BOX 997
WORTHINGTON MN
56187-2202
US

V. Phone/Fax

Practice location:
  • Phone: 507-372-3271
  • Fax:
Mailing address:
  • Phone: 507-372-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0900X
TaxonomyEnterostomal Therapy Registered Nurse
License Number108831
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA108831
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR2204752
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: