1316175011 NPI number — MRS. MALINA LYNN BAUER RDH

Table of content: MRS. MALINA LYNN BAUER RDH (NPI 1316175011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316175011 NPI number — MRS. MALINA LYNN BAUER RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUER
Provider First Name:
MALINA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BLADES
Provider Other First Name:
MALINA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316175011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1116 MAIDA VALE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASLET
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76052-5133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-439-2827
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12420 TIMBERLAND BLVD STE 416
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76248-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-518-1100
Provider Business Practice Location Address Fax Number:
817-518-1106
Provider Enumeration Date:
07/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 124Q00000X , with the licence number:  15414 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15414 . This is a "RDH LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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