Provider Demographics
NPI:1497274872
Name:BAGLEY, RACHEL (NP-C, RNFA)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:NP-C, RNFA
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:SQUICCIARINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C, RNFA
Mailing Address - Street 1:280 S MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3852
Mailing Address - Country:US
Mailing Address - Phone:714-634-4567
Mailing Address - Fax:
Practice Address - Street 1:280 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3852
Practice Address - Country:US
Practice Address - Phone:714-634-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-16
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA784138163WR0006X
CA95007462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant