Healthcare Provider Details

I. General information

NPI: 1376305888
Provider Name (Legal Business Name): LAUREN KATHLEEN BAILEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 EVERGREEN RD
DEARBORN MI
48128-2407
US

IV. Provider business mailing address

476 EMMONS BLVD
WYANDOTTE MI
48192-2404
US

V. Phone/Fax

Practice location:
  • Phone: 313-455-4018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704273092
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: