Provider Demographics
NPI:1144876178
Name:BAYLESS, SUZANNE ELIZABETH
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:BAYLESS
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 1:33187 S 1ST RD
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-5724
Mailing Address - Country:US
Mailing Address - Phone:402-223-8187
Mailing Address - Fax:
Practice Address - Street 1:1300 N 14TH ST
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-2135
Practice Address - Country:US
Practice Address - Phone:402-223-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20436164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse