Provider Demographics
NPI:1598574089
Name:HALSEY, MARY BAILEY
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BAILEY
Last Name:HALSEY
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 1:74658 CONYERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLATSKANIE
Mailing Address - State:OR
Mailing Address - Zip Code:97016-2705
Mailing Address - Country:US
Mailing Address - Phone:406-607-7038
Mailing Address - Fax:
Practice Address - Street 1:74658 CONYERS CREEK RD
Practice Address - Street 2:
Practice Address - City:CLATSKANIE
Practice Address - State:OR
Practice Address - Zip Code:97016-2705
Practice Address - Country:US
Practice Address - Phone:406-607-7038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABD61634184374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula