MEDICARE: SUSAN EILEEN BAILEY CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0038282	OH
2	363LF0000X	Family Nurse Practitioner	71007587A	IN

General Provider Information

NPI Number	:	1124540455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN EILEEN BAILEY CNP

Provider Business Mailing Address
First Line	:	3005 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4736
Country	:	US
Telephone Number	:	260-267-9498
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4736
Country	:	US
Telephone Number	:	260-267-9498
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2017
Last Update Date	:	09/17/2025

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