Provider Demographics
NPI:1588384473
Name:NOTZKE, BAILEY NICOLE (NP)
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:NICOLE
Last Name:NOTZKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:NICOLE
Other - Last Name:MARTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-4160
Mailing Address - Country:US
Mailing Address - Phone:217-343-6779
Mailing Address - Fax:
Practice Address - Street 1:1170 FORTUNE BLVD
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-7358
Practice Address - Country:US
Practice Address - Phone:844-872-6249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104757815363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health