Provider Demographics
NPI:1255923058
Name:BENZ, BAILEY E
Entity type:Individual
Prefix:MISS
First Name:BAILEY
Middle Name:E
Last Name:BENZ
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 1:8661 INDIGO TRL
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1574
Mailing Address - Country:US
Mailing Address - Phone:440-251-3249
Mailing Address - Fax:
Practice Address - Street 1:8661 INDIGO TRL
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1574
Practice Address - Country:US
Practice Address - Phone:440-251-3249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide