1689823551 NPI number — JOHANNES MICHAEL BAILEY RN, FNP, APRN-BC

Table of content: JOHANNES MICHAEL BAILEY RN, FNP, APRN-BC (NPI 1689823551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689823551 NPI number — JOHANNES MICHAEL BAILEY RN, FNP, APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
JOHANNES
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP, APRN-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689823551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 827
Provider Second Line Business Mailing Address:
BOX 362
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09617-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
00390815685311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 827
Provider Second Line Business Practice Location Address:
BOX 362
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09617-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
81-568-5311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WG0000X , with the licence number:  RN00143594 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: RN00143594 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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