| NPI | 1992059679 |
|---|---|
| Former Name | CAROLYN ELIZABETH BAGLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MA 2262975) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 2262975) |
| Enumeration Date | 2012-11-02 |
| Last Update Date | 2017-02-17 |