Provider Demographics
NPI:1477707933
Name:BAILEY, TRACY L (LPN)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:179 POINT PLEASANT RD # 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-1661
Mailing Address - Country:US
Mailing Address - Phone:585-815-9381
Mailing Address - Fax:
Practice Address - Street 1:179 POINT PLEASANT RD # 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-1661
Practice Address - Country:US
Practice Address - Phone:585-815-9381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272874164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse