Healthcare Provider Details

I. General information

NPI: 1144243189
Provider Name (Legal Business Name): REBECCA BAGLEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD HEALTH SCIENCE BUILDING ECU-COLLEGE OF NURSING
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

111 ESSEX DR
WINTERVILLE NC
28590-9435
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-6358
  • Fax: 252-744-6393
Mailing address:
  • Phone: 252-744-6358
  • Fax: 252-744-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number75262
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: