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NPI Code Detail

MEDICARE: PHILIP JOSEPH BAGNOLI RN

MEDICARE: PHILIP JOSEPH BAGNOLI RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WP0808XPsychiatric/Mental Health Registered Nurse1688296CO

General Provider Information

NPI Number : 1326900283
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP JOSEPH BAGNOLI RN
Provider Business Mailing Address
First Line : 805 TIMBER LN
Second Line :
City : FORT COLLINS
State : CO
Zip : 80521-3140
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1024 S LEMAY AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-3929
Country : US
Telephone Number : 970-495-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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