Provider Demographics
NPI:1316168404
Name:BAUER, CHRISTINA L
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:L
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:L
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:434 COURTNEY ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3014
Mailing Address - Country:US
Mailing Address - Phone:547-194-7600
Mailing Address - Fax:
Practice Address - Street 1:142 B ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1911
Practice Address - Country:US
Practice Address - Phone:541-941-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist