Provider Demographics
NPI:1275747693
Name:BAILEY, DIANA ROSE (CRNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ROSE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 LITTLE GLOUCESTER RD
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5256
Mailing Address - Country:US
Mailing Address - Phone:856-232-9939
Mailing Address - Fax:
Practice Address - Street 1:157 BUSTLETON PIKE # 161
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6456
Practice Address - Country:US
Practice Address - Phone:215-322-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily