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General NPI Number Information
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NPI Number | 1205238789
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Entity Type | Individual
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Provider Name | ELLEN PERRY-BAGEAC NP
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Gender | Female
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 3417 GASTON AVE STE 790
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City | DALLAS
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State | TX
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Zip | 75246
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Country | US
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Telephone | 214-821-5266
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Fax | 214-821-0459
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Provider Business Mailing Address
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Address Line | 2617 SW GEORGIAN PL
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City | PORTLAND
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State | OR
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Zip | 97201-1725
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Country | US
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Telephone | 503-267-9391
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP136153
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License Number State | TX
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