Provider Demographics
NPI:1306199542
Name:BAILEY, SHIBAHN JOLENE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SHIBAHN
Middle Name:JOLENE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:SHIBAHN
Other - Middle Name:JOLENE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:76 BIDDLE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-5274
Mailing Address - Country:US
Mailing Address - Phone:410-608-4906
Mailing Address - Fax:
Practice Address - Street 1:76 BIDDLE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-5274
Practice Address - Country:US
Practice Address - Phone:410-608-4906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN600681390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program