MEDICARE: NATALYA 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
1	164W00000X	Licensed Practical Nurse	72439	NC

General Provider Information

NPI Number	:	1699125484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALYA BAILEY

Provider Business Mailing Address
First Line	:	168 AVERASBORO DR
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-2687
Country	:	US
Telephone Number	:	919-327-0603
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 LUTHER RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1804
Country	:	US
Telephone Number	:	919-703-0800
Fax Number	:

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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Directions to “ NATALYA BAILEY ” Practice Location

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