Provider Demographics
NPI:1245858273
Name:BAILEY, EBONIE KIERRA (CD(DONA))
Entity type:Individual
Prefix:
First Name:EBONIE
Middle Name:KIERRA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 GABRIELLE WAY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3963
Mailing Address - Country:US
Mailing Address - Phone:916-949-8757
Mailing Address - Fax:
Practice Address - Street 1:6302 GABRIELLE WAY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3963
Practice Address - Country:US
Practice Address - Phone:916-949-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA13718374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula