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Individual
SHELLY A BAUER
Active
Individual
SHELLY A BAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
209006891
IL
363L00000X
Nurse Practitioner
209006891
IL
363LF0000X
Family Nurse Practitioner
Primary
209006891
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209006891
STATE LICENSE
IL
Enumeration date
04/17/2008
Last updated
10/19/2018
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