Provider Demographics
NPI:1114663911
Name:BIRD, BAILEE DEE
Entity Type:Individual
Prefix:MRS
First Name:BAILEE
Middle Name:DEE
Last Name:BIRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 65 BOX 20
Mailing Address - Street 2:
Mailing Address - City:BLUEBELL
Mailing Address - State:UT
Mailing Address - Zip Code:84007-9701
Mailing Address - Country:US
Mailing Address - Phone:435-253-0384
Mailing Address - Fax:
Practice Address - Street 1:12330 W 3000 N
Practice Address - Street 2:
Practice Address - City:BLUEBELL
Practice Address - State:UT
Practice Address - Zip Code:84007-9701
Practice Address - Country:US
Practice Address - Phone:435-253-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program