Provider Demographics
NPI:1649324989
Name:BAILEY ANDERSON, PHYLLIS F (RN PC)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:F
Last Name:BAILEY ANDERSON
Suffix:
Gender:F
Credentials:RN PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PILGRIM TRL
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5432
Mailing Address - Country:US
Mailing Address - Phone:508-747-9671
Mailing Address - Fax:
Practice Address - Street 1:166 PILGRIM TRL
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-5432
Practice Address - Country:US
Practice Address - Phone:508-747-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA148826163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPNV2 70010000PN0076Medicare UPIN