MEDICARE: WENDY L BAUER R.N, C.N.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.121353-COA1	OH
2	364S00000X	Clinical Nurse Specialist	COA.03285-NS	OH

General Provider Information

NPI Number	:	1376767228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY L BAUER R.N, C.N.S.

Provider Business Mailing Address
First Line	:	5982 RHODES RD
Second Line	:
City	:	KENT
State	:	OH
Zip	:	44240-8100
Country	:	US
Telephone Number	:	330-673-1347
Fax Number	:	330-678-3677

Provider Business Practice Location Address
First Line	:	799 S MAIN ST
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45804-1519
Country	:	US
Telephone Number	:	419-229-2222
Fax Number	:	419-229-2227

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	05/01/2017

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