Individual
LEAH MICHELLE BAGLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
420 POLIFKA DR, SHAW AFB, SC 29152-5100
(803) 895-6191
Mailing address
420 POLIFKA DR, SHAW AFB, SC 29152-5100
(803) 895-6191
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24751
SC
363LF0000X
Family Nurse Practitioner
RN262574
GA
Other
Enumeration date
03/27/2020
Last updated
11/25/2024
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