Individual
MRS. LYNSEY MARIE BAGOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1101 W UNIVERSITY DR, ROCHESTER, MI 48307-1863
(248) 652-5354
(248) 652-5861
Mailing address
42180 TODDMARK LN APT 12, CLINTON TWP, MI 48038-5491
(248) 860-3501
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704250789
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704250789
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12164771
CAQH
MI
Enumeration date
07/28/2010
Last updated
11/06/2012
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