Healthcare Provider Details

I. General information

NPI: 1740678598
Provider Name (Legal Business Name): KIMBERLEY BAUER NATUROPATHIC PHYSICIAN AND LICENSED MIDWIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 01/02/2015
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: DR. KIMBERLEY A BAUER
Title or Position: DOCTOR
Credential: ND LM
Phone: 360-384-2900