Provider Demographics
NPI:1386320646
Name:BAUER, ASHLEY A
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:A
Last Name:BAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:A
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-5211
Mailing Address - Country:US
Mailing Address - Phone:701-934-2336
Mailing Address - Fax:
Practice Address - Street 1:104 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-5211
Practice Address - Country:US
Practice Address - Phone:701-934-2336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant