Individual
LACI BAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 333-2225
(208) 706-7516
Mailing address
520 S EAGLE RD STE 1243, MERIDIAN, ID 83642-6355
(208) 333-2225
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
62999
ID
Other
Enumeration date
10/31/2019
Last updated
12/05/2019
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