| NPI | 1326160094 |
|---|---|
| Former Name | MELISSA LEE BAGWELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA MD.202898) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 134675) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2009-11-18 |