MEDICARE: MS. SIDNEY PRICE BAILEY RN BSN CDE

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	163WD0400X	Diabetes Educator Registered Nurse	418788	TX

General Provider Information

NPI Number	:	1386973139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SIDNEY PRICE BAILEY RN BSN CDE

Provider Business Mailing Address
First Line	:	1606 AUSTIN ST
Second Line	:
City	:	LA MARQUE
State	:	TX
Zip	:	77568-5053
Country	:	US
Telephone Number	:	409-457-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 AUSTIN ST
Second Line	:
City	:	LA MARQUE
State	:	TX
Zip	:	77568-5053
Country	:	US
Telephone Number	:	409-457-6225
Fax Number	:

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

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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