Healthcare Provider Details

I. General information

NPI: 1467689315
Provider Name (Legal Business Name): BRENDA KAY BAILEY R. N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

749 TOWNSHIP ROAD 462
SULLIVAN OH
44880-9754
US

IV. Provider business mailing address

749 TOWNSHIP ROAD 462
SULLIVAN OH
44880-9754
US

V. Phone/Fax

Practice location:
  • Phone: 440-724-1835
  • Fax:
Mailing address:
  • Phone: 440-724-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 328116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: