Healthcare Provider Details

I. General information

NPI: 1669868170
Provider Name (Legal Business Name): MICHELLE BAYLEY LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC BAVARIA CMR 411 BLDG 700 ROSE BARRACKS
APO AE
09112
US

IV. Provider business mailing address

USA MEDDAC BAVARIA CMR 411 BLDG 700 ROSE BARRACKS
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 499662834719
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number150595
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: