Healthcare Provider Details

I. General information

NPI: 1023993623
Provider Name (Legal Business Name): BAILEY RUDOLPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W CENTRAL AVE STE 105
TOLEDO OH
43606-3819
US

IV. Provider business mailing address

5110 LIBBEY RD
PERRYSBURG OH
43551-9758
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4590
  • Fax: 419-291-4593
Mailing address:
  • Phone: 419-806-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0040032
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number489659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: