Provider Demographics
NPI:1306490982
Name:BAUMAN, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1831
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-1831
Mailing Address - Country:US
Mailing Address - Phone:907-707-5723
Mailing Address - Fax:
Practice Address - Street 1:301 E DANNA AVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6422
Practice Address - Country:US
Practice Address - Phone:907-357-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician