Provider Demographics
NPI:1215171384
Name:BAUER, MARY E (RN, MS, CNM)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:BAUER
Suffix:
Gender:F
Credentials:RN, MS, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:620 S COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4657
Mailing Address - Country:US
Mailing Address - Phone:630-789-6217
Mailing Address - Fax:630-655-0531
Practice Address - Street 1:2233 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8151
Practice Address - Country:US
Practice Address - Phone:630-789-6217
Practice Address - Fax:630-655-0531
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007532176B00000X
IL209007532367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife