Provider Demographics
NPI:1134251549
Name:BAILES, ALICE (CNM)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:BAILES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 CALMES NECK LN
Mailing Address - Street 2:
Mailing Address - City:BOYCE
Mailing Address - State:VA
Mailing Address - Zip Code:22620-2605
Mailing Address - Country:US
Mailing Address - Phone:540-837-1846
Mailing Address - Fax:703-549-4821
Practice Address - Street 1:1501 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2716
Practice Address - Country:US
Practice Address - Phone:703-549-5070
Practice Address - Fax:703-549-4821
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024084760367A00000X
MDAC000179367A00000X
DCRN40773367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01647B03Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER