Provider Demographics
NPI:1558771337
Name:LAGRONE, ELICIA
Entity Type:Individual
Prefix:
First Name:ELICIA
Middle Name:
Last Name:LAGRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 BENJAMIN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3225
Mailing Address - Country:US
Mailing Address - Phone:616-323-4219
Mailing Address - Fax:
Practice Address - Street 1:1112 BENJAMIN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3225
Practice Address - Country:US
Practice Address - Phone:616-323-4219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health