=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093110595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLLEEN BAUDER RN, BSN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2014
-----------------------------------------------------
Last Update Date | 10/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 HANCOCK ST
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-272-0232
-----------------------------------------------------
Fax | 989-797-3477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 HANCOCK ST
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48602-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-272-0232
-----------------------------------------------------
Fax | 989-797-3477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0809X
-----------------------------------------------------
Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number | 4704138437
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------