Provider Demographics
NPI:1245789197
Name:BAILEY, ANGELA RAE (CNA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RAE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:RAE
Other - Last Name:BAILEY-HARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:4239 CLAY PL SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-6353
Mailing Address - Country:US
Mailing Address - Phone:541-619-8107
Mailing Address - Fax:
Practice Address - Street 1:4239 CLAY PL SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322-6353
Practice Address - Country:US
Practice Address - Phone:541-619-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201111140CNA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide