Basic Information
| Provider Information | |||||||||
| NPI: | 1457699001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUERS | ||||||||
| FirstName: | ARIELE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, CNM | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4705 MONTGOMERY BLVD NE STE 301 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871091234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057274500 | ||||||||
| FaxNumber: | 5057274505 | ||||||||
| Practice Location | |||||||||
| Address1: | 4705 MONTGOMERY BLVD NE STE 301 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057274500 | ||||||||
| FaxNumber: | 5057274505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 77129 | NM | N | Nursing Service Providers | Registered Nurse | 163W00000X | 777330 | CA | N | Nursing Service Providers | Registered Nurse | 367A00000X | 701 | NM | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LP0808X | 55838 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 04488555 | 05 | NM | MEDICAID |