Healthcare Provider Details

I. General information

NPI: 1730636895
Provider Name (Legal Business Name): KARA BAUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SAFE HAVEN ROAD
POWELL WY
82435
US

IV. Provider business mailing address

112 SAFE HAVEN ROAD
POWELL WY
82435
US

V. Phone/Fax

Practice location:
  • Phone: 307-645-3384
  • Fax:
Mailing address:
  • Phone: 307-645-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number37982
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: