Provider Demographics
NPI:1467075630
Name:BAILEY, RHIANNON ROSE (PA-C)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:ROSE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37098 CAMELOT DR APT 8
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2454
Mailing Address - Country:US
Mailing Address - Phone:248-459-4047
Mailing Address - Fax:
Practice Address - Street 1:37098 CAMELOT DR APT 8
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2454
Practice Address - Country:US
Practice Address - Phone:248-459-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009947TMP20363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant