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General NPI Number Information
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NPI Number | 1174306484
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Entity Type | Individual
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Provider Name | BAILEY MARIE JENKINS
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Gender | Female
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Dates
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Enumeration Date | 08/18/2023
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Last Update Date | 05/13/2024
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Provider Practice Location Address
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Address Line | 4700 S CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60632-2016
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Country | US
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Telephone | 773-584-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 WOLF RD
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City | INDIAN HEAD PARK
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State | IL
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Zip | 60525-4369
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Country | US
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Telephone | 248-752-7108
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209028548
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License Number State | IL
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