Provider Demographics
NPI:1134122757
Name:SLAGER, JOAN K (CNM)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:K
Last Name:SLAGER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-9611
Mailing Address - Country:US
Mailing Address - Phone:269-341-7875
Mailing Address - Fax:269-341-6261
Practice Address - Street 1:3681 S 26TH ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-9611
Practice Address - Country:US
Practice Address - Phone:269-341-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704132728367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2939513Medicaid
MIM74680004Medicare PIN