Basic Information
Provider Information
NPI: 1811044100
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAILEY
FirstName: CYNTHIA
MiddleName: M
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 690 CANTON ST
Address2: STE 325
City: WESTWOOD
State: MA
PostalCode: 020902324
CountryCode: US
TelephoneNumber: 7814077713
FaxNumber: 7814070998
Practice Location
Address1: 455 TOLL GATE RD
Address2:  
City: WARWICK
State: RI
PostalCode: 028862759
CountryCode: US
TelephoneNumber: 4017381516
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/05/2007
LastUpdateDate: 05/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XR096285MDN Other Service ProvidersSpecialist 
367500000XRNA36681RIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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