Provider Demographics
NPI:1457673998
Name:BAILEY, JUNELLE JODEEN (RN)
Entity Type:Individual
Prefix:MS
First Name:JUNELLE
Middle Name:JODEEN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 42ND ST
Mailing Address - Street 2:AB1
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2863
Mailing Address - Country:US
Mailing Address - Phone:718-396-7520
Mailing Address - Fax:
Practice Address - Street 1:4307 42ND ST
Practice Address - Street 2:AB1
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-2863
Practice Address - Country:US
Practice Address - Phone:718-396-7520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299649164W00000X
NY663098163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY299649OtherNYS LPN LICENSE