Individual
MRS. HEATHER COTTON BAGLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Mailing address
2080 W ARLINGTON BLVD STE B, GREENVILLE, NC 27834-3770
(252) 752-2140
(252) 689-6502
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
145586
NC
367500000X
Certified Registered Nurse Anesthetist
072154
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
1974
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052642
—
NC
01
—
P00600557
RAILROAD MEDICARE
NC
Enumeration date
08/30/2006
Last updated
04/23/2021
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