Provider Demographics
NPI:1477707370
Name:BAILEY, TIFFANY DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DAWN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4043 CREST DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1201
Mailing Address - Country:US
Mailing Address - Phone:937-520-6878
Mailing Address - Fax:
Practice Address - Street 1:4043 CREST DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1201
Practice Address - Country:US
Practice Address - Phone:937-520-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN106081164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse