Provider Demographics
NPI:1912422544
Name:BAUMAN, SUSAN KAY
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 17TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1373
Mailing Address - Country:US
Mailing Address - Phone:507-358-3637
Mailing Address - Fax:
Practice Address - Street 1:3805 17TH AVE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1373
Practice Address - Country:US
Practice Address - Phone:507-358-3637
Practice Address - Fax:507-358-3637
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN959924400029343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)