Provider Demographics
NPI:1285917914
Name:BAGG, RICHARD EVANS (RN/NP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:EVANS
Last Name:BAGG
Suffix:
Gender:M
Credentials:RN/NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 BARNABAS RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-1841
Mailing Address - Country:US
Mailing Address - Phone:508-566-1554
Mailing Address - Fax:
Practice Address - Street 1:331 E FALMOUTH HWY
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536-6039
Practice Address - Country:US
Practice Address - Phone:508-495-0704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN264769363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health