Healthcare Provider Details

I. General information

NPI: 1770295560
Provider Name (Legal Business Name): BAILEY ANNABELLE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2022
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W 7TH AVE
EUGENE OR
97401-1100
US

IV. Provider business mailing address

968 CALVIN ST
EUGENE OR
97401-5318
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-4041
  • Fax:
Mailing address:
  • Phone: 206-475-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201906561RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: