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NPI Code Detail

MEDICARE: RITA MARIE GAGE LPN

MEDICARE: RITA MARIE GAGE LPN
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
1164W00000XLicensed Practical Nurse4703045061MI

General Provider Information

NPI Number : 1407315021
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA MARIE GAGE LPN
Provider Business Mailing Address
First Line : 6820 SUZANNE CT
Second Line :
City : HOWARD CITY
State : MI
Zip : 49329-9213
Country : US
Telephone Number : 231-408-4281
Fax Number :
Provider Business Practice Location Address
First Line : 5300 PATTERSON AVE SE STE 125
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-9627
Country : US
Telephone Number : 616-222-5601
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2019
Last Update Date : 03/13/2019

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