Provider Demographics
NPI:1427064708
Name:BAGGE, MARLA J (CNM, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:J
Last Name:BAGGE
Suffix:
Gender:F
Credentials:CNM, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-4069
Mailing Address - Country:US
Mailing Address - Phone:630-989-8904
Mailing Address - Fax:
Practice Address - Street 1:525 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-4069
Practice Address - Country:US
Practice Address - Phone:630-989-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001903367A00000X
IL209012338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife