Healthcare Provider Details

I. General information

NPI: 1730155250
Provider Name (Legal Business Name): ANDREA M BAYLISS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BVLD
KETTERING OH
45429
US

IV. Provider business mailing address

3533 SOUTHERN BLVD SUITE 3100
KETTERING OH
45429-1264
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-8228
  • Fax: 937-293-8229
Mailing address:
  • Phone: 937-293-8228
  • Fax: 937-293-8229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0991232-CRNA
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN-261227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: