Provider Demographics
NPI:1306199542
Name:BAILEY, SHIBAHN JOLENE (CRNA, MS)
Entity type:Individual
Prefix:
First Name:SHIBAHN
Middle Name:JOLENE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CRNA, MS
Other - Prefix:
Other - First Name:SHIBAHN
Other - Middle Name:JOLENE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:108 ABBEVILLE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7379
Mailing Address - Country:US
Mailing Address - Phone:410-608-4906
Mailing Address - Fax:
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN600681390200000X
NC3590367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program