Provider Demographics
NPI:1083060842
Name:BAUER, DANIELLE (RD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BAUER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 E COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:MI
Mailing Address - Zip Code:48854-1345
Mailing Address - Country:US
Mailing Address - Phone:517-883-5028
Mailing Address - Fax:517-883-5028
Practice Address - Street 1:776 E COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-1345
Practice Address - Country:US
Practice Address - Phone:517-883-5028
Practice Address - Fax:517-883-5028
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI929865133V00000X
MI133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist