Provider Demographics
NPI:1902139363
Name:BAUER, MOLLY M (ARNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:BAUER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:M
Other - Last Name:VONNAHME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1007
Mailing Address - Country:US
Mailing Address - Phone:319-356-4107
Mailing Address - Fax:319-356-7455
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1007
Practice Address - Country:US
Practice Address - Phone:319-356-4107
Practice Address - Fax:319-356-7455
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC115268363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI09230272Medicare PIN