Provider Demographics
NPI:1851056840
Name:BAILEY, YOHANCE (LPN)
Entity Type:Individual
Prefix:
First Name:YOHANCE
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2403
Mailing Address - Country:US
Mailing Address - Phone:917-536-0844
Mailing Address - Fax:
Practice Address - Street 1:305 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2403
Practice Address - Country:US
Practice Address - Phone:917-536-0844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308981-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse