Provider Demographics
NPI:1710280797
Name:BAGWELL, HAYLEY ANN (CNIM)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:ANN
Last Name:BAGWELL
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:350 INTERLOCKEN BLVD
Mailing Address - Street 2:STE 360
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3477
Mailing Address - Country:US
Mailing Address - Phone:303-339-1499
Mailing Address - Fax:303-339-1498
Practice Address - Street 1:350 INTERLOCKEN BLVD
Practice Address - Street 2:STE 360
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-3477
Practice Address - Country:US
Practice Address - Phone:303-339-1499
Practice Address - Fax:303-339-1498
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic