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NPI Code Detail

MEDICARE: DEANNA LYN BAILEY

MEDICARE:   DEANNA LYN BAILEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1053608125
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANNA LYN BAILEY
Provider Business Mailing Address
First Line : 2 LAKEVIEW DR
Second Line :
City : NORTH GRAFTON
State : MA
Zip : 01536-1518
Country : US
Telephone Number : 774-293-4421
Fax Number :
Provider Business Practice Location Address
First Line : 2 LAKEVIEW DR
Second Line :
City : NORTH GRAFTON
State : MA
Zip : 01536-1518
Country : US
Telephone Number : 774-293-4421
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2011
Last Update Date : 07/08/2011

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Directions to “ DEANNA LYN BAILEY ” Practice Location

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