Healthcare Provider Details

I. General information

NPI: 1295446706
Provider Name (Legal Business Name): TERESA LYNNE BAUER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. TERESA LYNNE VITITOE

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 MEMORIAL DRIVE STE 250
SAINT LOUIS MO
63195-0001
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-257-6480
  • Fax: 618-235-2620
Mailing address:
  • Phone: 618-257-6480
  • Fax: 618-235-2620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209035026
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2022042404
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2022042404
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: