Provider Demographics
NPI:1538277017
Name:BAGLIERI, CATHERINE PECORINO (FNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:PECORINO
Last Name:BAGLIERI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 WINDSOR AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1141
Mailing Address - Country:US
Mailing Address - Phone:617-312-1936
Mailing Address - Fax:
Practice Address - Street 1:1006 MANTUA PIKE
Practice Address - Street 2:
Practice Address - City:WOODBURY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08097-1221
Practice Address - Country:US
Practice Address - Phone:856-845-8181
Practice Address - Fax:856-845-8586
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010519363LF0000X
NJ26NJ00089200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ139018XVAMedicare PIN