Provider Demographics
NPI:1366051864
Name:BAYLESS, JULIA ALLISTAIR (RN)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:ALLISTAIR
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ALLISTAIR
Other - Last Name:ROBERTSON-BAYLESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3516 3RD AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-4524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 HIDDEN LAKES PKWY
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4286
Practice Address - Country:US
Practice Address - Phone:763-588-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2459016163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice