Provider Demographics
NPI:1912294067
Name:BAILEY, EDWINA ROSHON
Entity Type:Individual
Prefix:MRS
First Name:EDWINA
Middle Name:ROSHON
Last Name:BAILEY
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 1:2731 CELEBRATE CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-6998
Mailing Address - Country:US
Mailing Address - Phone:702-326-6018
Mailing Address - Fax:
Practice Address - Street 1:2731 CELEBRATE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6998
Practice Address - Country:US
Practice Address - Phone:702-326-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner