MEDICARE: TREY NNORMAN BAILEY RN

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	163W00000X	Registered Nurse	201042450RN	OR

General Provider Information

NPI Number	:	1932532850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREY NNORMAN BAILEY RN

Provider Business Mailing Address
First Line	:	419 NW 29TH ST
Second Line	:
City	:	REDMOND
State	:	OR
Zip	:	97756-7320
Country	:	US
Telephone Number	:	541-788-0583
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 E ASHWOOD RD
Second Line	:
City	:	MADRAS
State	:	OR
Zip	:	97741-9703
Country	:	US
Telephone Number	:	541-325-5195
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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