Provider Demographics
NPI:1467689315
Name:BAILEY, BRENDA KAY (R N)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 TOWNSHIP ROAD 462
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:OH
Mailing Address - Zip Code:44880-9754
Mailing Address - Country:US
Mailing Address - Phone:440-724-1835
Mailing Address - Fax:
Practice Address - Street 1:749 TOWNSHIP ROAD 462
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:OH
Practice Address - Zip Code:44880-9754
Practice Address - Country:US
Practice Address - Phone:440-724-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 328116163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse