Healthcare Provider Details

I. General information

NPI: 1578448460
Provider Name (Legal Business Name): PROMISE HAGEDON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 STEWART MOUNTAIN DR
EAGLE RIVER AK
99577-9013
US

IV. Provider business mailing address

2600 CORDOVA ST STE 101
ANCHORAGE AK
99503-2745
US

V. Phone/Fax

Practice location:
  • Phone: 907-694-3336
  • Fax:
Mailing address:
  • Phone: 907-279-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNURR31118
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: