=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023993623
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BAILEY RUDOLPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2025
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2130 W CENTRAL AVE STE 105
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43606-3819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-291-4590
-----------------------------------------------------
Fax | 419-291-4593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5110 LIBBEY RD
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-9758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-806-9222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 489659
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0040032
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------