Provider Demographics
NPI:1699166199
Name:BAUMAN, LOUELLA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LOUELLA
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 E FLORENTINE RD STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2245
Mailing Address - Country:US
Mailing Address - Phone:928-277-1211
Mailing Address - Fax:928-277-1239
Practice Address - Street 1:7750 E FLORENTINE RD STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2245
Practice Address - Country:US
Practice Address - Phone:928-277-1211
Practice Address - Fax:928-277-1239
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7624363LF0000X
AZTAP7624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ146029Medicaid