Provider Demographics
NPI:1750638037
Name:BAILEY, BEATRICE LYNETTE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:BEATRICE
Middle Name:LYNETTE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25740 MESA CT
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3074
Mailing Address - Country:US
Mailing Address - Phone:909-881-1683
Mailing Address - Fax:909-881-4215
Practice Address - Street 1:249 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3707
Practice Address - Country:US
Practice Address - Phone:909-881-1683
Practice Address - Fax:909-881-4215
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF0712247164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse