Healthcare Provider Details

I. General information

NPI: 1871855940
Provider Name (Legal Business Name): ANNE ELIZABETH HAGBOM RN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE PEDIATRIC PREPARE, 3RD FLOOR
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

400 PARNASSUS AVE PEDIATRIC PREPARE, 3RD FLOOR
SAN FRANCISCO CA
94143-2202
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-8529
  • Fax:
Mailing address:
  • Phone: 415-353-8529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number641070
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number85837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: