Provider Demographics
NPI:1780928960
Name:BAYER, NANCY JAN (LPN)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JAN
Last Name:BAYER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2823
Mailing Address - Country:US
Mailing Address - Phone:573-581-1037
Mailing Address - Fax:573-581-1037
Practice Address - Street 1:312 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2823
Practice Address - Country:US
Practice Address - Phone:573-581-1037
Practice Address - Fax:573-581-1037
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO036999164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse