Provider Demographics
NPI:1851791669
Name:BARGEN, ANITA CAROL
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:CAROL
Last Name:BARGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40324 W NOVAK LN
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-6682
Mailing Address - Country:US
Mailing Address - Phone:480-772-0085
Mailing Address - Fax:
Practice Address - Street 1:40324 W NOVAK LN
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-6682
Practice Address - Country:US
Practice Address - Phone:480-772-0085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9577233747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant