Provider Demographics
NPI:1568225563
Name:BAGAGA, MELINDA J
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:J
Last Name:BAGAGA
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 1:15350 LARSEN AVE
Mailing Address - Street 2:
Mailing Address - City:GOWEN
Mailing Address - State:MI
Mailing Address - Zip Code:49326-9585
Mailing Address - Country:US
Mailing Address - Phone:616-970-5150
Mailing Address - Fax:
Practice Address - Street 1:15350 LARSEN AVE
Practice Address - Street 2:
Practice Address - City:GOWEN
Practice Address - State:MI
Practice Address - Zip Code:49326-9585
Practice Address - Country:US
Practice Address - Phone:616-970-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula