Provider Demographics
NPI:1912536137
Name:BAILEY, MARY (CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4299
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 105
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3541
Practice Address - Country:US
Practice Address - Phone:419-479-5605
Practice Address - Fax:419-473-2049
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.026619363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0459041Medicaid
OH404119OtherOHIO BOARD OF NURSING
OHAPRN.CNP.026619OtherOHIO BOARD OF NURSING