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Individual

DR. SANDRA W BAGLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN PHD MSW

Contact information

Practice address
3683 WILDE ROSE LANE, SALT LAKE CITY, UT 84109
(801) 273-0295
Mailing address
3683 WILDE ROSE LANE, SALT LAKE CITY, UT 84109
(801) 273-0295

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
1166903502
UT
106H00000X
Marriage & Family Therapist
1166903902
UT
363LF0000X
Family Nurse Practitioner
Primary
1166904405
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
U000075209
PTAN
UT
Enumeration date
07/28/2006
Last updated
03/04/2013
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