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General NPI Number Information
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NPI Number | 1205284213
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Entity Type | Individual
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Provider Name | ANDREA L BAILEY RD, LD
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Gender | Female
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 2518 N LANCASTER DR
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City | BOISE
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State | ID
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Zip | 83702-0635
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Country | US
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Telephone | 208-991-2066
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Fax |
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Provider Business Mailing Address
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Address Line | 2518 N LANCASTER DR
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City | BOISE
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State | ID
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Zip | 83702-0635
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Country | US
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Telephone | 208-991-2066
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND-11269
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | L007017
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-1027
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License Number State | ID
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