Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1427406347 |
---|---|
Provider Name | Gloria Bailey |
First Address | Hyattsville, MD 20784-1229 |
Second Address | Hyattsville, MD 20784-1229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 22/08/2021 |