Provider Demographics
NPI:1558620120
Name:BAGNEKI, BLANCHE LAURE
Entity type:Individual
Prefix:MRS
First Name:BLANCHE
Middle Name:LAURE
Last Name:BAGNEKI
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 1:2705 SIR MICHAEL PL
Mailing Address - Street 2:
Mailing Address - City:GLENARDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1687
Mailing Address - Country:US
Mailing Address - Phone:240-705-7374
Mailing Address - Fax:
Practice Address - Street 1:2705 SIR MICHAEL PL
Practice Address - Street 2:
Practice Address - City:GLENARDEN
Practice Address - State:MD
Practice Address - Zip Code:20706-1687
Practice Address - Country:US
Practice Address - Phone:240-705-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
MDS 412092488618374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171M00000XOther Service ProvidersCase Manager/Care Coordinator