Provider Demographics
NPI:1700144961
Name:BAILEY, BENJAMIN E (RN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:E
Last Name:BAILEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 E BASELINE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4671
Mailing Address - Country:US
Mailing Address - Phone:480-981-2400
Mailing Address - Fax:480-981-2407
Practice Address - Street 1:1900 N HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-1604
Practice Address - Country:US
Practice Address - Phone:480-981-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN179341163W00000X
AZCRNA0943367500000X
NVCRNA000479367500000X
NVRN84000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse