Provider Demographics
NPI:1912197914
Name:BAGLEY, JENNIFER ELIZABETH (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GREAT MOOSE DR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04943-3022
Mailing Address - Country:US
Mailing Address - Phone:207-270-4060
Mailing Address - Fax:207-270-4063
Practice Address - Street 1:10 GREAT MOOSE DR
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:ME
Practice Address - Zip Code:04943-3022
Practice Address - Country:US
Practice Address - Phone:207-270-4060
Practice Address - Fax:207-270-4063
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81850363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care