MEDICARE: MS. ANDREA RENE BAILER MSN, CRNP

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	363LP0200X	Pediatric Nurse Practitioner	SP007072	PA

General Provider Information

NPI Number	:	1932182300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA RENE BAILER MSN, CRNP

Provider Business Mailing Address
First Line	:	814 FEDERAL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-5007
Country	:	US
Telephone Number	:	610-405-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 MARKET ST
Second Line	:	4TH FLOOR ADOLESCENT CARE CENTER
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3329
Country	:	US
Telephone Number	:	215-590-3537
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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