Healthcare Provider Details

I. General information

NPI: 1578995171
Provider Name (Legal Business Name): MICHELLE HOPE HAGAN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16053 HIGHWAY 72
ROGERSVILLE AL
35652-8141
US

IV. Provider business mailing address

PO BOX 401
ROGERSVILLE AL
35652-0401
US

V. Phone/Fax

Practice location:
  • Phone: 256-247-0093
  • Fax: 256-247-5289
Mailing address:
  • Phone: 256-247-0093
  • Fax: 256-247-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number137509
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-099297
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-099297
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: