Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 016582-21 | NH |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 016582-23 | NH |
NPI | 1619986361 |
---|---|
Provider Name | Phyllis A Hagan |
First Address | Raymond, NH 03077-1220 |
Second Address | Raymond, NH 03077-1220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 07/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2301906YPNH01 | ANTHEM (01) | NH |
30009619 | (05) | NH |
313480099 | (05) | ME |
S24426 | (02) |