Provider Demographics
NPI:1497482343
Name:BAILEY, LISA MARIA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:BAILEY
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 1:127 GARRETT MILLS LN
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-9734
Mailing Address - Country:US
Mailing Address - Phone:304-918-4236
Mailing Address - Fax:
Practice Address - Street 1:127 GARRETT MILLS LN
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-9734
Practice Address - Country:US
Practice Address - Phone:304-918-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant