Provider Demographics
NPI:1396257903
Name:BAUER, ALLISON LAINE (NP-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LAINE
Last Name:BAUER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12289 HANCOCK ST STE 34
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5888
Mailing Address - Country:US
Mailing Address - Phone:317-815-8950
Mailing Address - Fax:317-815-8951
Practice Address - Street 1:12289 HANCOCK ST STE 34
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5888
Practice Address - Country:US
Practice Address - Phone:317-815-8950
Practice Address - Fax:317-815-8951
Is Sole Proprietor?:No
Enumeration Date:2017-11-05
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007679A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ1127022OtherMEDICARE PTAN
ININ1125023OtherMEDICARE PTAN
IN300037435Medicaid