Provider Demographics
NPI:1174003420
Name:BAILEY, IVIE BUNMI (LVN)
Entity Type:Individual
Prefix:
First Name:IVIE
Middle Name:BUNMI
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19638 SAN GABRIEL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5217
Mailing Address - Country:US
Mailing Address - Phone:818-960-5003
Mailing Address - Fax:
Practice Address - Street 1:3315 MARQUART ST STE 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6027
Practice Address - Country:US
Practice Address - Phone:713-799-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334049164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse