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General NPI Number Information
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NPI Number | 1760461008
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Entity Type | Individual
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Provider Name | COLETTE RAE BAILEY RN
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Gender | Female
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Dates
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Enumeration Date | 01/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1020 S MAIN ST SUITE 100
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City | SALT LAKE CITY
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State | UT
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Zip | 84101-3176
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Country | US
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Telephone | 801-539-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 1758 E 11400 S
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City | SANDY
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State | UT
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Zip | 84092-5430
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Country | US
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Telephone | 801-571-8837
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 5644173-3102
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License Number State | UT
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