Provider Demographics
NPI:1902284987
Name:BAILEY-WHIGHAM, GLENDA DIANA
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:DIANA
Last Name:BAILEY-WHIGHAM
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 1:1215 FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3403
Mailing Address - Country:US
Mailing Address - Phone:757-390-9174
Mailing Address - Fax:
Practice Address - Street 1:1215 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3403
Practice Address - Country:US
Practice Address - Phone:757-390-9174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor