Basic Information
| Provider Information | |||||||||
| NPI: | 1538606660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | PAULINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2411 CARDINAL AVE NW | ||||||||
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| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358161717 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 CHATEAU DR SW STE 110 | ||||||||
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| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564697895 | ||||||||
| FaxNumber: | 2562708937 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2017 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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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 | 367500000X | 113075 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.