MEDICARE: HENRRY E MARADIAGA RN

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	RN9649607	FL

General Provider Information

NPI Number	:	1912858614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRRY E MARADIAGA RN

Provider Business Mailing Address
First Line	:	50221 THATCHER ST
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-0054
Country	:	US
Telephone Number	:	571-320-9486
Fax Number	:

Provider Business Practice Location Address
First Line	:	50221 THATCHER ST
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-0054
Country	:	US
Telephone Number	:	571-320-9486
Fax Number	:

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

Provider Enumeration Date	:	02/07/2026
Last Update Date	:	02/07/2026

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