1164421731 NPI number — ELIZABETH L THOMAS-BAUER DNP, FNP-BC, CNE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164421731 NPI number — ELIZABETH L THOMAS-BAUER DNP, FNP-BC, CNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS-BAUER
Provider First Name:
ELIZABETH
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP, FNP-BC, CNE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164421731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 SUNSET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19809-2019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-563-9666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 PHILADELPHIA PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYMONT
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19703-2431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-317-1531
Provider Business Practice Location Address Fax Number:
302-291-4986
Provider Enumeration Date:
07/18/2005

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: 363LF0000X , with the licence number:  LG-0000177 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000978242 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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