Provider Demographics
NPI:1982993564
Name:BAILEY, BRENDA FAYE
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:FAYE
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 1:839 CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-8210
Mailing Address - Country:US
Mailing Address - Phone:740-244-2056
Mailing Address - Fax:
Practice Address - Street 1:839 CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-8210
Practice Address - Country:US
Practice Address - Phone:740-244-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN102857IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse