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NPI Code Detail

MEDICARE: ELIZABETH DEMAAGD PNP-PC

MEDICARE: ELIZABETH DEMAAGD PNP-PC
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
1363L00000XNurse Practitioner20173648MI
2363LP0200XPediatric Nurse Practitioner20173648MI

General Provider Information

NPI Number : 1427568021
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH DEMAAGD PNP-PC
Provider Business Mailing Address
First Line : 1045 GRISWOLD ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49507-3810
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 MICHIGAN ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-267-1090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2017
Last Update Date : 02/20/2026

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Directions to “ ELIZABETH DEMAAGD PNP-PC” Practice Location

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