Provider Demographics
NPI:1194884577
Name:BAUER, SANDRA FRANCES (ANP)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:FRANCES
Last Name:BAUER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3017
Mailing Address - Country:US
Mailing Address - Phone:607-733-6698
Mailing Address - Fax:
Practice Address - Street 1:147 W GRAY ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3017
Practice Address - Country:US
Practice Address - Phone:607-733-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300558-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB8498Medicare ID - Type Unspecified
NYR88534Medicare UPIN