Individual
MRS. MICHELLE A BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., NP-C
Contact information
Practice address
11055 TWIN CREEKS CV, FORT WAYNE, IN 46845-2204
(260) 425-6120
(260) 425-6115
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28158098A
IN
363L00000X
Nurse Practitioner
Primary
71002670A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000617878
ANTHEM
IN
01
—
000000617879
ANTHEM
IN
05
—
200905320
—
IN
Enumeration date
05/13/2008
Last updated
10/20/2022
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