Provider Demographics
NPI:1487172409
Name:BAUMAN, MELODY ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:ANN
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:MELODY
Other - Middle Name:ANN
Other - Last Name:FITZGERALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1505 EASTLAND DR, OSF CRITICAL CANE, PULMONARY, SLEEP M
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701
Mailing Address - Country:US
Mailing Address - Phone:309-661-2368
Mailing Address - Fax:309-662-9709
Practice Address - Street 1:1505 EASTLAND DR, OSF CRITICAL CANE, PULMONARY, SLEEP M
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-661-2368
Practice Address - Fax:309-662-9709
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006316363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant