Provider Demographics
NPI:1104894989
Name:BAGGSTROM, BARBARA (CPNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BAGGSTROM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ROUTE 10 E
Mailing Address - Street 2:STE 203
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-1925
Mailing Address - Country:US
Mailing Address - Phone:973-659-9991
Mailing Address - Fax:973-659-9632
Practice Address - Street 1:765 ROUTE 10 E
Practice Address - Street 2:STE 203
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-1925
Practice Address - Country:US
Practice Address - Phone:973-659-9991
Practice Address - Fax:973-659-9632
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00086700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner