Provider Demographics
NPI:1386403764
Name:BAYLESS, CHRISTINA DAWN
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:DAWN
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 SHIVENER RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-8999
Mailing Address - Country:US
Mailing Address - Phone:937-779-6002
Mailing Address - Fax:
Practice Address - Street 1:488 SHIVENER RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-8999
Practice Address - Country:US
Practice Address - Phone:937-779-6002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide