Healthcare Provider Details

I. General information

NPI: 1174358386
Provider Name (Legal Business Name): BAILEY JO FIJALKOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PINE AVE
SAINT CLAIRSVILLE OH
43950-8737
US

IV. Provider business mailing address

623 PARK ST
BARNESVILLE OH
43713-1156
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-4925
  • Fax:
Mailing address:
  • Phone: 304-218-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0037476
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: