1336417161 NPI number — NICOLE ANNE BAILEY D.C.

Table of content: NICOLE ANNE BAILEY D.C. (NPI 1336417161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336417161 NPI number — NICOLE ANNE BAILEY D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
NICOLE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1336417161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 RACINE DR
Provider Second Line Business Mailing Address:
ST 100
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-8770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-798-5560
Provider Business Mailing Address Fax Number:
910-798-5561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4829 CONVOY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92111-1610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-7223
Provider Business Practice Location Address Fax Number:
858-279-5343
Provider Enumeration Date:
12/07/2011

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: 111N00000X , with the licence number:  4374 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 32146 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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