Healthcare Provider Details

I. General information

NPI: 1366759805
Provider Name (Legal Business Name): KATHLEEN ANNETTE HAGAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W KAAHUMANU AVE
KAHULUI HI
96732-1643
US

IV. Provider business mailing address

32 HOKU PL
PAIA HI
96779-8122
US

V. Phone/Fax

Practice location:
  • Phone: 808-984-3493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN 58675
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAPRN 932
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: