MEDICARE: JANICE H HAGE APRN-BC

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	363LA2100X	Acute Care Nurse Practitioner	5003891	NC
2	363LA2100X	Acute Care Nurse Practitioner	3423	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NC9144A	OTHER	NC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952588345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE H HAGE APRN-BC

Provider Business Mailing Address
First Line	:	424 SAINT GEORGE RD
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6976
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 INDIA HOOK RD
Second Line	:	SUITE 120
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2784
Country	:	US
Telephone Number	:	803-328-8255
Fax Number	:	803-328-8265

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

Provider Enumeration Date	:	01/28/2008
Last Update Date	:	06/15/2015

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Directions to “ JANICE H HAGE APRN-BC” Practice Location

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