Healthcare Provider Details

I. General information

NPI: 1477548600
Provider Name (Legal Business Name): TANYA BAILEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOLBROOK STREET OB-GYN ASSOCIATES
DANVILLE VA
24541
US

IV. Provider business mailing address

101 HOLBROOK STREET OB-GYN ASSOCIATES
DANVILLE VA
24541
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-7765
  • Fax: 434-793-4061
Mailing address:
  • Phone: 434-792-7765
  • Fax: 434-793-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number10666CNM293
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNC293 ACNM10666
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024180078
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: