Provider Demographics
NPI:1720135627
Name:DAGEN, JULIMARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JULIMARIE
Middle Name:
Last Name:DAGEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 MERCY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1881
Mailing Address - Country:US
Mailing Address - Phone:231-733-1912
Mailing Address - Fax:231-737-4603
Practice Address - Street 1:1250 MERCY DR STE 101
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1881
Practice Address - Country:US
Practice Address - Phone:231-733-1912
Practice Address - Fax:231-737-4603
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704105570163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP47833Medicare UPIN