Basic Information
| Provider Information | |||||||||
| NPI: | 1114906120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUMAN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | RN NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | PO BOX 8674 | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | 5076251878 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 E MAIN ST | ||||||||
| Address2: | MANKATO CLINIC AT MAIN STREET | ||||||||
| City: | MANKATO | ||||||||
| State: | MN | ||||||||
| PostalCode: | 560015066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076251811 | ||||||||
| FaxNumber: | 5076251878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R0743451 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 599214100 | 05 | MN | MEDICAID | NA2951023871 | 01 | MN | PREFERRED ONE | OTHER | 03A64BA | 01 | MN | BCBS | OTHER | 500004161 | 01 | RR MEDICARE | OTHER | 41084933956001C158 | 01 | CHAMPUS | OTHER | 938480 | 05 | IA | MEDICAID | 0401492 | 01 | MN | MEDICA | OTHER | 124709 | 01 | MN | UCARE | OTHER | HP40993 | 01 | MN | HEALTH PARTNERS | OTHER |