Provider Demographics
NPI:1063121572
Name:WALCZAK, BAILEY NICOLE (DNP, FNP)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:NICOLE
Last Name:WALCZAK
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 US HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:COSMOPOLIS
Mailing Address - State:WA
Mailing Address - Zip Code:98537-9701
Mailing Address - Country:US
Mailing Address - Phone:360-580-1093
Mailing Address - Fax:
Practice Address - Street 1:757 US HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:COSMOPOLIS
Practice Address - State:WA
Practice Address - Zip Code:98537-9701
Practice Address - Country:US
Practice Address - Phone:360-580-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61381509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily