Provider Demographics
NPI:1417613944
Name:BAILEY-WILSON, SYREETA
Entity Type:Individual
Prefix:
First Name:SYREETA
Middle Name:
Last Name:BAILEY-WILSON
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 1:1549 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-2931
Mailing Address - Country:US
Mailing Address - Phone:856-979-3332
Mailing Address - Fax:
Practice Address - Street 1:1549 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-2931
Practice Address - Country:US
Practice Address - Phone:856-979-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula