Provider Demographics
NPI:1023357605
Name:BAGAIPO, ATHENA THERESA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:THERESA
Last Name:BAGAIPO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 ALMOND CT
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-3141
Mailing Address - Country:US
Mailing Address - Phone:908-968-3030
Mailing Address - Fax:
Practice Address - Street 1:290 RED SCHOOL LN
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2276
Practice Address - Country:US
Practice Address - Phone:908-246-7060
Practice Address - Fax:610-335-4404
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00442900363LF0000X
NY33 336397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily