=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912536137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY BAILEY CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2020
-----------------------------------------------------
Last Update Date | 03/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4126 N HOLLAND SYLVANIA RD STE 105
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-3541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-479-5605
-----------------------------------------------------
Fax | 419-473-2049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4235 SECOR RD
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43623-4299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-473-3561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.026619
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------