Individual
LYNN EBERTS FAGERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
426 MICHIGAN ST NE, SUITE 102, GRAND RAPIDS, MI 49503-5623
(616) 391-2957
(616) 391-3950
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704123571
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4493574
—
MI
01
—
5008700690
BCBS PIN
MI
01
—
500D111300
BCBS GROUP
MI
Enumeration date
06/07/2006
Last updated
01/06/2025
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