Individual
MARY SUE BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CIC
Contact information
Practice address
101 S MOORE AVE, CLAREMORE, OK 74017-5091
(918) 342-6200
Mailing address
101 S MOORE AVE, CLAREMORE, OK 74017-5091
(918) 342-6200
Taxonomy
Speciality
Code
Description
License number
State
163WI0600X
Infection Control Registered Nurse
Primary
69423
OK
163WX0106X
Occupational Health Registered Nurse
69423
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1254799595
DOD
OK
Enumeration date
08/30/2019
Last updated
08/30/2019
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