Provider Demographics
NPI:1639534720
Name:BAILEY, DANA (FNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 SE 91ST AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3749
Mailing Address - Country:US
Mailing Address - Phone:503-775-6500
Mailing Address - Fax:503-775-2275
Practice Address - Street 1:9300 SE 91ST AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-3749
Practice Address - Country:US
Practice Address - Phone:503-775-6500
Practice Address - Fax:503-775-2275
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201509218NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner