Provider Demographics
NPI:1144243189
Name:BAGLEY, REBECCA (CNM)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9435
Mailing Address - Country:US
Mailing Address - Phone:252-744-6358
Mailing Address - Fax:252-744-6393
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:HEALTH SCIENCE BUILDING ECU-COLLEGE OF NURSING
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-6358
Practice Address - Fax:252-744-6393
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75262176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife