Healthcare Provider Details

I. General information

NPI: 1922254879
Provider Name (Legal Business Name): BERNADINE AGATHA BAILEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10409 SWEET BAY DRIVE
CLINTON MD
20735
US

IV. Provider business mailing address

7111 MOORES RD
BRANDYWINE MD
20613-9062
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-7566
  • Fax:
Mailing address:
  • Phone: 301-928-9899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR122460
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: