Healthcare Provider Details

I. General information

NPI: 1639869209
Provider Name (Legal Business Name): BAILEY WALTERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD
EAST LANSING MI
48823-5376
US

IV. Provider business mailing address

605 GLEN CT
RIDGECREST CA
93555-4965
US

V. Phone/Fax

Practice location:
  • Phone: 517-432-6144
  • Fax: 517-432-6150
Mailing address:
  • Phone: 760-977-7836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: