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General NPI Number Information
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NPI Number | 1598594152
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Entity Type | Individual
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Provider Name | MRS. EVITA BAILEY
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Gender | Female
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Dates
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Enumeration Date | 07/31/2024
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Last Update Date | 07/31/2024
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Provider Practice Location Address
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Address Line | 1612 VIRGINIA PARK ST
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City | DETROIT
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State | MI
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Zip | 48206-2420
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Country | US
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Telephone | 313-661-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 7436 OAKLAND ST # 1021
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City | DETROIT
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State | MI
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Zip | 48211-1352
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Country | US
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Telephone | 313-434-8004
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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