Provider Demographics
NPI:1316077084
Name:BAILEY, SANDY D (RN)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:D
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12180 E RUSTLER RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-8527
Mailing Address - Country:US
Mailing Address - Phone:928-526-2524
Mailing Address - Fax:
Practice Address - Street 1:1601 S LONE TREE RD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6446
Practice Address - Country:US
Practice Address - Phone:928-773-4062
Practice Address - Fax:928-773-4070
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN081194163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ130619Medicaid