Provider Demographics
NPI:1336236611
Name:BAILEY, RUBY J (RN)
Entity Type:Individual
Prefix:
First Name:RUBY
Middle Name:J
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3367
Mailing Address - Country:US
Mailing Address - Phone:219-944-4187
Mailing Address - Fax:219-944-4196
Practice Address - Street 1:2269 WEST 25TH AVENUE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-4509
Practice Address - Country:US
Practice Address - Phone:219-944-4187
Practice Address - Fax:219-944-4196
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001895363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN198260JMedicare PIN
INQ49799Medicare UPIN