Healthcare Provider Details

I. General information

NPI: 1871185504
Provider Name (Legal Business Name): CHERITH HAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR BLDG 7500
FORT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR
FORT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7543
  • Fax: 719-526-7850
Mailing address:
  • Phone: 719-526-7543
  • Fax: 719-526-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN.240138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: