Provider Demographics
NPI:1134304801
Name:BAGAN, EVE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:EVE
Middle Name:
Last Name:BAGAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MISS
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:ROLLINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7619 E ROCKMONT RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:WI
Mailing Address - Zip Code:54864
Mailing Address - Country:US
Mailing Address - Phone:715-399-8054
Mailing Address - Fax:715-399-8054
Practice Address - Street 1:7619 E ROCKMONT RD
Practice Address - Street 2:S/A
Practice Address - City:POPLAR
Practice Address - State:WI
Practice Address - Zip Code:54864
Practice Address - Country:US
Practice Address - Phone:715-399-8054
Practice Address - Fax:715-399-8054
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1341810163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse