Provider Demographics
NPI:1548884133
Name:BAILEY, RENEE
Entity type:Individual
Prefix:MRS
First Name:RENEE
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 1:6301 14TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-8003
Mailing Address - Country:US
Mailing Address - Phone:202-210-6938
Mailing Address - Fax:
Practice Address - Street 1:1434 4TH ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2204
Practice Address - Country:US
Practice Address - Phone:301-792-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X, 247200000X
DC3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider