Healthcare Provider Details

I. General information

NPI: 1477540300
Provider Name (Legal Business Name): ELIZABETH BAILEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 PRESCOTT RD
MODESTO CA
95356-8418
US

IV. Provider business mailing address

4120 PRESCOTT RD
MODESTO CA
95356-8418
US

V. Phone/Fax

Practice location:
  • Phone: 209-544-7300
  • Fax: 209-544-7323
Mailing address:
  • Phone: 209-544-7300
  • Fax: 209-544-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN283230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: