Provider Demographics
NPI:1417436684
Name:BAGWELL, NNEKA (APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:NNEKA
Middle Name:
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13806 SHANNOCK LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8468
Mailing Address - Country:US
Mailing Address - Phone:202-716-2978
Mailing Address - Fax:
Practice Address - Street 1:13806 SHANNOCK LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8468
Practice Address - Country:US
Practice Address - Phone:202-716-2978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD188563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily