| NPI | 1265060479 |
|---|---|
| Former Name | MADELYN ROSE BAGWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA 343560) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN DO5088) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-07-30 |