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General NPI Number Information
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NPI Number | 1104158088
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Entity Type | Individual
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Provider Name | AMY B BAILEY ANP
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Gender | Female
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 1300 ROANOKE AVE
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City | RIVERHEAD
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State | NY
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Zip | 11901-2031
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Country | US
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Telephone | 631-548-6207
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Fax |
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Provider Business Mailing Address
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Address Line | 44 STOLL DRIVE PO BOX 1223
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City | JAMESPORT
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State | NY
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Zip | 11947-1223
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Country | US
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Telephone | 631-284-3114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 304566
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License Number State | NY
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