Provider Demographics
NPI:1174186589
Name:BAGDON, DANIELLE (FNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BAGDON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 BUCKINGHAM BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3210
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD STE 210
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1941
Practice Address - Country:US
Practice Address - Phone:410-729-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF01190286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily