MEDICARE: MARISSA LYNN HAGON

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	163W00000X	Registered Nurse	2221083256	MI

General Provider Information

NPI Number	:	1043179815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA LYNN HAGON

Provider Business Mailing Address
First Line	:	6260 CHESTNUT LN
Second Line	:
City	:	BURTON
State	:	MI
Zip	:	48519-1370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3438 LENNON RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-1017
Country	:	US
Telephone Number	:	810-676-3331
Fax Number	:

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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