Individual
MANDIE E BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
310 W PLAZA DR, CARTERVILLE, IL 62918-1980
(618) 985-4344
(618) 985-6469
Mailing address
310 W PLAZA DR, CARTERVILLE, IL 62918-1980
(618) 985-4344
(618) 985-6469
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209007566
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209007566
IL
Other
Enumeration date
06/04/2009
Last updated
01/08/2025
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