Provider Demographics
NPI:1346953452
Name:BAITY, ASHLEY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:BAITY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 GUM SPRINGS RD.
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:IL
Mailing Address - Zip Code:62972
Mailing Address - Country:US
Mailing Address - Phone:618-771-7353
Mailing Address - Fax:
Practice Address - Street 1:4260 GUM SPRINGS RD.
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:IL
Practice Address - Zip Code:62972
Practice Address - Country:US
Practice Address - Phone:618-771-7353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041393701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse