Provider Demographics
NPI:1750156675
Name:LINGENFELTER-SHIREMAN, BAILEE
Entity type:Individual
Prefix:
First Name:BAILEE
Middle Name:
Last Name:LINGENFELTER-SHIREMAN
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 1:6941 S VILLAGE RIVER LN APT 12
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-5653
Mailing Address - Country:US
Mailing Address - Phone:385-222-9097
Mailing Address - Fax:
Practice Address - Street 1:6941 S VILLAGE RIVER LN APT 12
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-5653
Practice Address - Country:US
Practice Address - Phone:385-222-9097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13095523-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse