Provider Demographics
NPI:1508745233
Name:BAGNALL, ERIN DEMARS
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:DEMARS
Last Name:BAGNALL
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:SUMMER
Other - Last Name:DEMARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:1534 N. MOORPARK RD. PO BOX #256
Mailing Address - Street 2:PO BOX 256
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5129
Mailing Address - Country:US
Mailing Address - Phone:310-625-2257
Mailing Address - Fax:
Practice Address - Street 1:1534 N. MOORPARK RD. PO BOX #256
Practice Address - Street 2:PO BOX 256
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5129
Practice Address - Country:US
Practice Address - Phone:310-625-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily