Healthcare Provider Details

I. General information

NPI: 1700143385
Provider Name (Legal Business Name): TANIA CRISTINA BAILEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 23RD ST SE
SALEM OR
97301-6607
US

IV. Provider business mailing address

220 23RD ST SE
SALEM OR
97301-6607
US

V. Phone/Fax

Practice location:
  • Phone: 408-221-5357
  • Fax:
Mailing address:
  • Phone: 408-221-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10058510
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: