Healthcare Provider Details

I. General information

NPI: 1932898368
Provider Name (Legal Business Name): ELLEN M BAILEY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 MIDDLE ST APT 1
PORTSMOUTH NH
03801-7014
US

IV. Provider business mailing address

815 MIDDLE ST APT 1
PORTSMOUTH NH
03801-7014
US

V. Phone/Fax

Practice location:
  • Phone: 914-588-9216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ELLEN MARIE BAILEY
Title or Position: RN
Credential: RN
Phone: 914-588-9216