| Doctor Name: | ANITA BAGSTAD |
| NPI Number: | 1205206117 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN,CNP |
| License Number: | CNP 4147 |
| Business Practice Address: | 705 Pleasant Ave S Park Rapids, MN - 564701440 |
| Business Phone Number: | 2187322800 |
| Business Fax Number: | 2187322857 |
| Mailing Address: | 1027 Washington Ave, DETROIT LAKES |
| State: | MN |
| Postal Code: | 565013409 |
| Phone Number: | 2187322800 |
| Fax Number: | 2187322857 |
| NPI Enumeration Date: | 10/05/2015 |
| NPI Last Update Date: | 12/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | CNP 4147 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |