Provider Demographics
NPI:1356492540
Name:BAGWELL, RICHARD ANDREW (LPN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANDREW
Last Name:BAGWELL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6469 PENICK DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2832
Mailing Address - Country:US
Mailing Address - Phone:614-501-0211
Mailing Address - Fax:
Practice Address - Street 1:6469 PENICK DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2832
Practice Address - Country:US
Practice Address - Phone:614-501-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-112232 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse