Provider Demographics
NPI:1205303229
Name:BAUER, ERICA HAEDRICH (PA-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:HAEDRICH
Last Name:BAUER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:HAEDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44172 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MCARTHUR
Mailing Address - State:CA
Mailing Address - Zip Code:96056-8560
Mailing Address - Country:US
Mailing Address - Phone:530-717-0324
Mailing Address - Fax:
Practice Address - Street 1:20641 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4380
Practice Address - Country:US
Practice Address - Phone:530-335-6070
Practice Address - Fax:530-338-3368
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty