Provider Demographics
NPI:1093704553
Name:BAYLES, LISA H (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:H
Last Name:BAYLES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10026 OLD OCEAN CITY BLVD
Mailing Address - Street 2:BUILDING ONE
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1288
Mailing Address - Country:US
Mailing Address - Phone:410-641-9450
Mailing Address - Fax:410-641-9515
Practice Address - Street 1:10231 OLD OCEAN CITY BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3568
Practice Address - Country:US
Practice Address - Phone:410-629-6870
Practice Address - Fax:410-641-3140
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR060296363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD552105000Medicaid
MDKP95D869Medicare ID - Type Unspecified
MD552105000Medicaid