Healthcare Provider Details

I. General information

NPI: 1972896017
Provider Name (Legal Business Name): BRENDA BAILEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

1121 LORI CT
XENIA OH
45385-5734
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2007
  • Fax:
Mailing address:
  • Phone: 937-901-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN329906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: