Healthcare Provider Details

I. General information

NPI: 1568634202
Provider Name (Legal Business Name): KIMBERLEY A BAUER ND LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 MAIN ST SUITE 3
FERNDALE WA
98248-8605
US

IV. Provider business mailing address

2376 MAIN ST SUITE 3
FERNDALE WA
98248-8605
US

V. Phone/Fax

Practice location:
  • Phone: 360-384-2900
  • Fax: 360-384-2955
Mailing address:
  • Phone: 360-384-2900
  • Fax: 360-384-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60020654
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMIDW.MW.00000322
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: