Provider Demographics
NPI:1326661075
Name:BAYSINGER, NICOLE S
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:BAYSINGER
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 1:818 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-4666
Mailing Address - Country:US
Mailing Address - Phone:618-417-2382
Mailing Address - Fax:
Practice Address - Street 1:405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE RIVE
Practice Address - State:IL
Practice Address - Zip Code:62810-1228
Practice Address - Country:US
Practice Address - Phone:618-316-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker