Basic Information
Provider Information
NPI: 1124009469
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAHR
FirstName: BARBARA
MiddleName: ILEENE
NamePrefix: MS.
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 820 N CHELAN AVE
Address2:  
City: WENATCHEE
State: WA
PostalCode: 988012028
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 916 KOALA AVE
Address2:  
City: OMAK
State: WA
PostalCode: 988419576
CountryCode: US
TelephoneNumber: 5098261800
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/11/2005
LastUpdateDate: 01/24/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAP30001839WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
020534601WAL&IOTHER
963226605WA MEDICAID
894067301WACRIME VICTIMSOTHER


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