Healthcare Provider Details

I. General information

NPI: 1427064708
Provider Name (Legal Business Name): MARLA J BAGGE CNM, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W MADISON AVE
WHEATON IL
60187-4069
US

IV. Provider business mailing address

525 W MADISON AVE
WHEATON IL
60187-4069
US

V. Phone/Fax

Practice location:
  • Phone: 630-989-8904
  • Fax:
Mailing address:
  • Phone: 630-989-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209001903
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209012338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: