Individual
LITA C BAILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1217 BONITA ST, GRANTS, NM 87020-2103
(505) 287-2950
(505) 287-2403
Mailing address
1217 BONITA ST, GRANTS, NM 87020-2103
(505) 287-2950
(505) 287-2403
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP081328
ME
363LF0000X
Family Nurse Practitioner
R029543
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
335260099
—
ME
Enumeration date
08/08/2006
Last updated
10/27/2011
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