Provider Demographics
NPI:1841744133
Name:BAILEY, MAUREEN CECELIA (PA)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:CECELIA
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:CECELIA
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10000 SE MAIN ST STE 45
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2461
Mailing Address - Country:US
Mailing Address - Phone:503-251-6352
Mailing Address - Fax:503-261-6769
Practice Address - Street 1:10123 SE MARKET ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2532
Practice Address - Country:US
Practice Address - Phone:503-251-6352
Practice Address - Fax:503-261-6769
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR177305363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical