Provider Demographics
NPI:1417205949
Name:BAGEON, DANA THERESA (ARNP)
Entity type:Individual
Prefix:MS
First Name:DANA
Middle Name:THERESA
Last Name:BAGEON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 WAYZATA BLVD E STE 120
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-1984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1120 WAYZATA BLVD E STE 120
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1984
Practice Address - Country:US
Practice Address - Phone:952-443-4600
Practice Address - Fax:952-456-6633
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12744363LP0808X
FLARNP9200809363LF0000X
KY3014513363LF0000X
VA0024170958363LF0000X
MDAC001508363LF0000X
SC18099363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily