Provider Demographics
NPI:1598594152
Name:BAILEY, EVITA
Entity type:Individual
Prefix:MRS
First Name:EVITA
Middle Name:
Last Name:BAILEY
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 1:7436 OAKLAND ST # 1021
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48211-1352
Mailing Address - Country:US
Mailing Address - Phone:313-434-8004
Mailing Address - Fax:
Practice Address - Street 1:1612 VIRGINIA PARK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-2420
Practice Address - Country:US
Practice Address - Phone:313-661-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker