MEDICARE: IYONNA BAGGETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1770281206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IYONNA BAGGETT

Provider Business Mailing Address
First Line	:	2112 BROADWAY ST NE STE 225
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-3081
Country	:	US
Telephone Number	:	612-643-9336
Fax Number	:	612-643-9336

Provider Business Practice Location Address
First Line	:	2112 BROADWAY ST NE STE 225
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-3081
Country	:	US
Telephone Number	:	612-643-9336
Fax Number	:	612-643-9336

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	02/23/2023

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Directions to “ IYONNA BAGGETT ” Practice Location

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