Healthcare Provider Details

I. General information

NPI: 1518624097
Provider Name (Legal Business Name): MARCY S PAGANELLI BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCY S PAGANELLI BA

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 10/05/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 SOMERSET DR NE
GRAND RAPIDS MI
49503-3900
US

IV. Provider business mailing address

478 SOMERSET DR NE
GRAND RAPIDS MI
49503-3900
US

V. Phone/Fax

Practice location:
  • Phone: 616-591-6996
  • Fax:
Mailing address:
  • Phone: 616-591-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: