Provider Demographics
NPI:1952829715
Name:BAILEY, GABRIELLE B
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:B
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 1:715 TERRACE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49440-1107
Mailing Address - Country:US
Mailing Address - Phone:231-830-9376
Mailing Address - Fax:
Practice Address - Street 1:3391 MERRIAM ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3155
Practice Address - Country:US
Practice Address - Phone:231-830-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI94708763301OtherPRIORITY HEALTH