Provider Demographics
NPI:1174381735
Name:BADDELEY, ALYSEN NICHOLE
Entity type:Individual
Prefix:
First Name:ALYSEN
Middle Name:NICHOLE
Last Name:BADDELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 KISER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PARIS
Mailing Address - State:OH
Mailing Address - Zip Code:43072-9782
Mailing Address - Country:US
Mailing Address - Phone:937-521-9178
Mailing Address - Fax:
Practice Address - Street 1:514 KISER LAKE RD
Practice Address - Street 2:
Practice Address - City:SAINT PARIS
Practice Address - State:OH
Practice Address - Zip Code:43072-9782
Practice Address - Country:US
Practice Address - Phone:937-521-9178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide