MEDICARE: TARA BAILEY LPN

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	164W00000X	Licensed Practical Nurse	26NP05684200	NJ

General Provider Information

NPI Number	:	1477749794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA BAILEY LPN

Provider Business Mailing Address
First Line	:	1112 DRAGSTON RD
Second Line	:
City	:	PORT NORRIS
State	:	NJ
Zip	:	08349-2508
Country	:	US
Telephone Number	:	800-950-6066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1112 DRAGSTON RD
Second Line	:
City	:	PORT NORRIS
State	:	NJ
Zip	:	08349-2508
Country	:	US
Telephone Number	:	800-950-6066
Fax Number	:

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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