Basic Information
| Provider Information | |||||||||
| NPI: | 1053623462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | NATALYA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 453 | ||||||||
| Address2: | |||||||||
| City: | KLAWOCK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999250453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074013138 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6341 E STREET | ||||||||
| Address2: | |||||||||
| City: | KLAWOCK | ||||||||
| State: | AK | ||||||||
| PostalCode: | 999250453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074013138 | ||||||||
| FaxNumber: | 9077554981 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 12/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 331089-3102 | UT | Y | Nursing Service Providers | Registered Nurse | 163WG0000X | 53100 | AK | N | Nursing Service Providers | Registered Nurse | General Practice | 163WG0000X | 331089-3102 | UT | N | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.