Healthcare Provider Details

I. General information

NPI: 1043633910
Provider Name (Legal Business Name): NATIEL OSWALD BAUER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 09/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E ROBINSON ST
NORMAN OK
73071-6610
US

IV. Provider business mailing address

9990 DOUBLE R BLVD STE 200
RENO NV
89521-4833
US

V. Phone/Fax

Practice location:
  • Phone: 405-364-7900
  • Fax: 405-310-6866
Mailing address:
  • Phone: 858-776-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54645
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1861
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: