Healthcare Provider Details

I. General information

NPI: 1437136140
Provider Name (Legal Business Name): NANCY HAGEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SULLIVAN AVE PRIME HEALTHCARE
SOUTH WINDSOR CT
06074-2713
US

IV. Provider business mailing address

30 JORDAN LN PRIME HEALTHCARE
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-1521
  • Fax: 860-644-3335
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number001961
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: