Individual provider Active NPI

Doreen Bagonza, RN BSN MPH CMSRN

  • Registered Nurse
  • Laurel, MD
National Provider Identifier
1164209573
Registry record updated Sep 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R220972 Issued in MD
Practice address
8108 Sandy Spring Rd
Laurel, MD 20707-3582
Phone
(301) 318-9833
NPI assigned
Sep 11, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X R220972 MD Primary

Addresses

Primary practice location

8108 Sandy Spring Rd
Laurel, MD 20707-3582

Mailing address

8108 Sandy Spring Rd
Laurel, MD 20707-3582
Phone (301) 318-9833

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
R220972MDMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1164209573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8108 SANDY SPRING RD",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207073582",
            "telephone_number": "301-318-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8108 SANDY SPRING RD",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207073582",
            "telephone_number": "301-318-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGONZA",
        "first_name": "DOREEN",
        "credential": "RN BSN MPH CMSRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-11",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "MD",
            "license": "R220972",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.