Healthcare Provider Details

I. General information

NPI: 1740977289
Provider Name (Legal Business Name): MICHELLE LAGINESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 S RIFE MEDICAL LN
ROGERS AR
72758-1452
US

IV. Provider business mailing address

510 WILSHIRE DR
BLOOMFIELD HILLS MI
48302-1068
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-8000
  • Fax:
Mailing address:
  • Phone: 734-250-3249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704325160
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN89397
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number236673
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number889325
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: