Provider Demographics
NPI:1255599288
Name:BAILEY, SUSAN M (NP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:2781 PILOT KNOB RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1119
Mailing Address - Country:US
Mailing Address - Phone:651-251-5132
Mailing Address - Fax:651-251-5111
Practice Address - Street 1:2781 PILOT KNOB RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121
Practice Address - Country:US
Practice Address - Phone:651-251-5132
Practice Address - Fax:651-251-5111
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704216119363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily