Provider Demographics
NPI:1861520108
Name:BAILEY, VANTEEN
Entity type:Individual
Prefix:MRS
First Name:VANTEEN
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 1:320 BROOKES DR
Mailing Address - Street 2:200
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-2736
Mailing Address - Country:US
Mailing Address - Phone:314-731-4800
Mailing Address - Fax:314-731-4896
Practice Address - Street 1:320 BROOKES DR SUITE 200
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042
Practice Address - Country:US
Practice Address - Phone:314-731-4800
Practice Address - Fax:314-731-4896
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO092177163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263930505Medicaid