Healthcare Provider Details

I. General information

NPI: 1043473267
Provider Name (Legal Business Name): MARY TERESA BAGSHAW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

DEPT 0861
DENVER CO
80256-0001
US

V. Phone/Fax

Practice location:
  • Phone: 970-244-1977
  • Fax: 970-244-2898
Mailing address:
  • Phone: 866-898-7136
  • Fax: 616-975-9824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number73645
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: