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General NPI Number Information
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NPI Number | 1275216699
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Entity Type | Individual
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Provider Name | NICHOLAS BAUDER APN
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Gender | Male
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Dates
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Enumeration Date | 08/11/2023
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 2148 VADALABENE DR
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City | MARYVILLE
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State | IL
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Zip | 62062-5632
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Country | US
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Telephone | 618-877-4420
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Fax |
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Provider Business Mailing Address
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Address Line | 1003 MARTIN LUTHER KING DR
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City | BLOOMINGTON
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State | IL
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Zip | 61701-1429
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Country | US
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Telephone | 888-924-3786
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2019043435
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041476077
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.032488
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License Number State | IL
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