Healthcare Provider Details

I. General information

NPI: 1861415382
Provider Name (Legal Business Name): SUSAN L BAUMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 E 9TH ST
RENO NV
89512-2964
US

IV. Provider business mailing address

1240 E 9TH ST
RENO NV
89512-2964
US

V. Phone/Fax

Practice location:
  • Phone: 775-323-0478
  • Fax:
Mailing address:
  • Phone: 775-323-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1385
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: