De La Rosa, Jennifer Bagwell

De La Rosa, Jennifer Bagwell is an individual health care provider with primary practice located at 1201 W Agency Rd , West Burlington IA 52655-1645. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. De La Rosa, Jennifer Bagwell can be contacted via phone (319) 754-4242.

Contact Information

Primary practice address
1201 W Agency Rd West Burlington IA 52655-1645
Phone: (319) 754-4242
Fax: (319) 754-4079
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X H0062423 Maryland

Profile Details

NPI number 1417915208
LBN Legal business name De La Rosa, Jennifer Bagwell
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2006
Last updated Sep 14th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417915208 NPPES
Maryland MEDICAID 408962600

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