Individual
ELSA MAE Q BAGNULO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP, BC
Contact information
Practice address
11640 NORTHPARK DR, WAKE FOREST, NC 27587-5736
(919) 235-6540
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(877) 498-4490
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0050-03747
NC
Other
Enumeration date
12/24/2007
Last updated
12/01/2023
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