MEDICARE: MRS. TRACY L. BAILEY LPN

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
1	164W00000X	Licensed Practical Nurse	272874	NY

General Provider Information

NPI Number	:	1477707933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACY L. BAILEY LPN

Provider Business Mailing Address
First Line	:	179 POINT PLEASANT RD # 2
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14622-1661
Country	:	US
Telephone Number	:	585-815-9381
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 POINT PLEASANT RD # 2
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14622-1661
Country	:	US
Telephone Number	:	585-815-9381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	02/24/2012

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