Provider Demographics
NPI:1144745613
Name:DEMAAGD-RODRIGUEZ, MEGAN ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:DEMAAGD-RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:DEMAAGD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256 PROSPECT AVE SE APT 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4619
Mailing Address - Country:US
Mailing Address - Phone:616-566-3235
Mailing Address - Fax:
Practice Address - Street 1:1211 LAFAYETTE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5092
Practice Address - Country:US
Practice Address - Phone:616-336-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704308193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner