Individual
JENNIFER CHARNITA BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1100 W 6TH AVE, GARY, IN 46402-1711
(219) 306-0349
Mailing address
1100 W 6TH AVE, GARY, IN 46402-1711
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27065054A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510137391
EDGE WATER HEALTH
IN
Enumeration date
04/23/2018
Last updated
06/16/2018
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