Provider Demographics
NPI:1336201052
Name:BAGLEY, CONNIE DARLENE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:DARLENE
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 VALLE DEL SOL
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-5000
Mailing Address - Country:US
Mailing Address - Phone:760-806-4870
Mailing Address - Fax:760-806-4870
Practice Address - Street 1:4652 VALLE DEL SOL
Practice Address - Street 2:
Practice Address - City:BONSALL
Practice Address - State:CA
Practice Address - Zip Code:92003-5000
Practice Address - Country:US
Practice Address - Phone:760-806-4870
Practice Address - Fax:760-806-4870
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17719363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health