Healthcare Provider Details

I. General information

NPI: 1851046536
Provider Name (Legal Business Name): LAURA BAUER AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 34TH ST FL 10
NEW YORK NY
10016-4744
US

IV. Provider business mailing address

139 E 13TH ST APT 5B
NEW YORK NY
10003-5366
US

V. Phone/Fax

Practice location:
  • Phone: 212-731-6366
  • Fax:
Mailing address:
  • Phone: 845-913-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number432103
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: