Provider Demographics
NPI:1407101645
Name:TRESENRITER, BAILEY NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:NICOLE
Last Name:TRESENRITER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:22818 OLD US 20
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46516-9150
Mailing Address - Country:US
Mailing Address - Phone:574-389-1231
Mailing Address - Fax:
Practice Address - Street 1:801 WAYNE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9074
Practice Address - Country:US
Practice Address - Phone:574-389-1231
Practice Address - Fax:574-389-1232
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001404A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant