Provider Demographics
NPI:1922804764
Name:BAILEY, CONNIE SUE
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
Last Name:BAILEY
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 1:1818 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3532
Mailing Address - Country:US
Mailing Address - Phone:308-660-3014
Mailing Address - Fax:
Practice Address - Street 1:1818 W 5TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3532
Practice Address - Country:US
Practice Address - Phone:308-660-3014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant